Revision 43 for 'Acute sinusitis'

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Acute sinusitis

Acute sinusitis is an acute inflammation of the paranasal sinus mucosa that lasts less than four weeks and can occur in any of the paranasal sinuses. If the nasal cavity mucosa is also involved then the term rhinosinusitis may be used.

Clinical presentation

Fever, headache, postnasal discharge of thick sputum, nasal congestion and an abnormal sense of smell.

Pathology

Etiology

Usually following a viral upper respiratory tract infection. Dental caries, periapical abscess and oroantral fistulation lead to a spread of infection to the maxillary sinus. Cystic fibrosis and allergy are risk factors.

Other anatomical variants that may predispose to the inflammation include nasal septal deviation, a spur of the nasal septum and/or frontoethmoidal recess variants.

Radiographic features

An air-fluid level is the most typical imaging finding. However, it is only present in 25-50% of patients with acute sinusitis 4.

Plain radiograph

Opacification of the sinuses and air-fluid level best seen in the maxillary sinus. It does not allow assessment of the extent of inflammation and its complications.

CT

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

Rhinitis, often associated with sinusitis, is often characterized by thickening of the turbinates with obliteration of the surrounding air channels. This should not be confused with the normal nasal cycle.

MRI

Signal characteristics of the affected regions include

  • T1: mucosal thickening is isointense to soft tissue and fluid is hypointense
  • T2: both mucosal thickening and fluid are, to a variable degree, hyperintense
  • T1 C+ (Gd): inflamed mucosa enhances whilst fluid does not

Treatment and prognosis

Conservative medical treatment until the inflammation subsides and treatment of the cause, e.g. dental caries. If it becomes chronic sinusitis, functional endoscopic sinus surgery may be considered.

Complications

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