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Sinus CT
Aka: Sinus CT, CT Sinus, CT of paranasal sinuses
- See Also
- Sinusitis
- Sinus XRay
- Epidemiology
- High False Positive Rate
- Upper Respiratory Infection: 85% with CT changes
- Asymptomatic adults: 40% with CT changes
- References
- Gwaltney (1994) N Engl J Med 330:25-30 [PubMed]
- Havas (1988) Arch Otolaryngol Head Neck Surg 114:856 [PubMed]
- Advantages
- Much more sensitive than Sinus XRay
- Good Sinus Anatomy definition
- Views sphenoid and Ethmoid Sinuses well
- Defines osteomeatal complex well
- Indications
- Confusing presentation
- Evaluation before endoscopic surgery
- Sinusitis refractory to maximal medical management
- Recurrent Acute Sinusitis
- Persistent Chronic Sinusitis Symptoms
- Suspected Osteomeatal complex Occlusion
- Suspected Allergic Fungal Sinusitis
- Suspected Fungal Sinusitis or other complicated Sinusitis (e.g. Immunocompromised patients)
- Sinusitis complications (e.g. Cavernous Sinus Thrombosis)
- Technique
- Full Coronal non-contrast Sinus CT
- Standard view indicated in most cases
- Mucosal thickening >5mm is consistent with sinus infection
- Demonstrates fluid and mucosal edema, as well as bony destruction
- Fat stranding (increased density) may be present in para-sinus spaces
- Limited Sinus CT
- Consider as alternative to full Sinus CT
- Four non-contiguous 5 mm slices in coronal plane
- Frontal Sinus
- Anterior ethmoid and Maxillary Sinuses
- Posterior ethmoid and Maxillary Sinuses
- Sphenoid Sinus
- Advantages
- Less expensive
- Less radiation
- Disadvantage
- Unknown efficacy
- Contrast Sinus CT
- Indications
- Periorbital Cellulitis or abscess
- Vascular complications
- Cavernous Sinus Thrombosis
- Findings
- Necrotic tissue and fluid does not contrast enhance
- Inflamed, thickened mucosa contrast enhances
- Mucosa, fluid and soft tissue may be indistinguishable without contrast
- Consider IV contrast in complicated cases (e.g. vascular complications, Cavernous Sinus Thrombosis)
- Timing
- Perform during maximal medical therapy
- Delay if URI present
- Contraindications: Relative
- Submaximal medical Management
- Upper Respiratory Infection
- Acute sinus infection
- Interpretation
- Findings consistent with Rhinosinusitis
- Air-fluid levels
- Total opacification
- Mucosal thickening >5 mm
- Complications identified by Sinus CT
- Osteomeatal Complex Obstruction
- Allergic Fungal Sinusitis
- References
- Broder (2018) Crit Dec Emerg Med 32(10): 12-3
- Mukherji (1998) Radiology 207:417-22 [PubMed]
- Okuyemi (2002) Am Fam Physician 66:1882-6 [PubMed]