Tsunami Sinusitis

Fig.1: Water's view of the skull shows air-fluid levels (arrows) in bilateral maxillary sinuses in a victim of tsunami trauma.
Fig.2: Direct coronal CT image performed 1 month after Fig.1 shows resolution of left maxillary sinusitis but persistent right sided sinusitis. There is a conglomerate mass of high attenuation (arrowheads) with air in the right maxillary sinus.

Facts

• Sinusitis may occur in patients with tsunami trauma
• Found in 10% of all cases in one series
  
• Usually polymicrobial
• Sand may be present in the sinus, which is hyperattenuating on CT (likely related to sand composition) and located in the dependent portion of the sinuses. Sand and seawater may enter sinuses through ostia and retain within.

Today, 4 years ago, was the day of one of the world's worst natural disasters -- tsunami. More than 200 000 people were killed and missing. More than a million people were displaced.

Reference:
1. Kaewlai, et al. Radiologic findings in tsunami trauma: experience with 225 patients injured in the 2004 tsunami. Emerg Radiol 2007;14:395
2. Limchawalit, et al. Images in clinical medicine. Tsunami sinusitis. N Engl J Med 2005