Revision 22 for 'Acute sinusitis'

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Acute sinusitis

Acute sinusitis is an acute inflammation of the nasal and paranasal sinus mucosa that last less than four weeks and can occur in any of the paranasal sinues.

Clinical presentation

Fever, headache, post nasal discharge of thick sputum, nasal congestion and abnormal smell.

Pathology

Etiology

Usually following viral upper respiratory tract infection. Tooth cares, periapical abscess and oroantral fistula lead to spread of infection to maxillary sinus. Cystic fibrosis and allergy are risk factors. Other anatomical variants that may predispose to the inflammation include nasal septal deviation, spur and/or frontoethmoidal recess variants.

Radiographic features

Plain film

Opacification of the sinuses and air/fluid level best seen in maxillary sinus. Cannot assess extent of inflammation and its complications.

CT

Better anatomical delineation and assessment of inflammation extension, causes and complications. Peripheral mucosal thickening, air/fluid level, air bubbles within the fluid and obstruction of the ostiomeatal complexes are recognized findings.

MRI

T1WI can differentiate between the mucosal thickening which is iso-intense to soft tissue and fluid which is hypo-intense. They are both hyperintense in T2WI. Inflamed mucosa enhances in post contrast study while the fluid does not.

Complications

  • erosion through bone
    • subperiosteal abscess
      • frontal sinus superficially (Pott's puffy tumor)
      • frontal or ethmoidal sinuses into orbit

Treatment

Conservative medical treatment until the inflammation subsides and treatment of the cause e.g. tooth cares. If changes to chronic sinusitis functional endoscopic sinus surgery may be considered.

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