Acute Sinusitis

Water's view radiograph of the paranasal sinus shows an air fluid level in the left maxillary sinus (arrows) of a 56-year-old man.

Facts:

• Very common disease encountered by primary care physicians.
• Diagnostic imaging is generally used in cases of recurrent or complicated sinus disease.
• Plain radiography has a limited role in management of sinusitis

Imaging

• Mucosal thickening, air-fluid levels, complete opacification of the involved sinus
• Mucosal thickening seen in more than 90% of sinusitis case, but very nonspecific
• More specific = air-fluid levels and complete opacification -- but seen in only 60% of cases
• Interpretation can vary widely among observers, with a high rate of false-negative results
• Radiography is not useful in patients younger than 3 years because of poorly developed sinuses
• Because clinical judgment is sufficient to diagnose sinusitis in majority of cases, and empiric treatments are inexpensive and safe --- x-ray should be reserved for patients with persistent symptoms despite appropriate treatment.

Reference:

Okuyemi KS, Tsue TT. Radiologic imaging in the management of sinusitis. Am Fam Physician 2002; 15;66:1882-1887