Imaging of Paranasal Sinus Infections in Children: A Review

Abstract

Paranasal sinuses (PNS) infections are common in children. They may cause common and well-known complications, but also, unusual and potentially devastating complications. Diagnosing PNS infections and complications in children requires knowledge of the unique anatomy of the nasal cavity and the PNS. In fetal life, nasal mucosa evaginations into the lateral nasal walls initiate the development of the PNS. The PNS continue to develop after birth and complete their maturation and pneumatization at different ages during childhood which makes the pattern of PNS infections determined by patient age. Complications are caused by direct spread of the infection to the orbit, face, intracranial or osseous structures or hematogenous spread of the infection to the intracranial structures. Emergent imaging studies are often necessary in the evaluation of the complications in pediatric patients when the symptoms persist for 10 days and/or if there is evidence of intracranial or orbital complications. In addition, immunocompromised children are especially vulnerable to developing unusual complications. Computed tomography (CT) is excellent for determining whether there is intraorbital extension of PNS disease. However, when the infection approaches the orbital apex, a magnetic resonance imaging (MRI) study with contrast is necessary to assess spread into the cavernous sinus and the intracranial compartment. The goal of this manuscript is to review and characterize imaging findings of PNS infections using CT and MRI allowing determination of the extent of PNS infections and their common and unusual complications in children. In addition, a summary of the development of the normal PNS is provided.

Pädiatrische Rhinologie

“…The anatomic landmarks that are commonly visualized via CT in the case of surgery may also be indirectly visualized on MRI. Therefore, the authors suggest MRI as the imaging of choice for diagnosis and treatment planning in orbital complications of sinusitis [49]. In reality, the availability of an MRI examination can be a critical argument, as it is not available in every hospital around the clock.…”

“…In these cases, CT imaging can be considered espe-cially when orbital complications of the disease are suspected and need to be clarified. MRI is more informative in cases of involvement of the orbital structures for evaluation of intracranial involvement or involvement of the cavernous sinus [49]. Imaging is also indicated prior to surgery, usually involving computed tomography.…”

“…Die anatomischen Landmarken, die im Falle einer Operation über das CT üblicherweise dargestellt werden, können indirekt auch in der Kernspintomografie visualisiert sein. Daher schlagen die Autoren eine MRT als Bildgebung der Wahl zur Diagnosestellung und Therapieplanung bei orbitaler Komplikation einer Sinusitis vor [49]. In der Realität kann die Verfügbarkeit einer MRT-Untersuchung ein kritisches Argument sein, da diese nicht in jedem Krankenhaus rund um die Uhr gegeben ist.…”

Advanced imaging of head and neck infections

“… 70 The diagnostic performance of DWI and contrast‐enhanced MRI is equivalent in the detection of abscesses 71 . MR venography is useful in detecting internal jugular vein thrombophlebitis, including Lemierre's syndrome 72 . DWI can also detect thrombophlebitis due to high signal from intraluminal thrombus 70 .…”

“…71 MR venography is useful in detecting internal jugular vein thrombophlebitis, including Lemierre's syndrome. 72 DWI can also detect thrombophlebitis due to high signal F I G U R E 1 5 Forty-two-year-old male with a cholesteatoma of the left middle ear. The fusion image of diffusion-weighted imaging and T2-weighted image clearly shows the extent of mastoid extension of the cholesteatoma, which is easy to interpret (arrows).…”