Acute sinusitis

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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 sinuses.

Clinical presentation

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

Pathology

Aetiology

Usually following viral upper respiratory tract infection. ~~Tooth~~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, spur and/or frontoethmoidal recess variants.

Radiographic features

Plain radiograph

Opacification of the sinuses and air/fluid level best seen in the maxillary sinus. Cannot assess 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, air bubbles within the fluid and obstruction of the ostiomeatal complexes are recognised findings.

MRI

T1WI can differentiate between the mucosal thickening that is isointense to soft tissue and fluid that is hypointense. 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 puffy tumour)
  - frontal or ethmoidal sinuses into the orbit (subperiosteal abscess of the orbit)
dural venous sinus thrombosis
intracranial extension
- meningitis
- subdural empyema
- cerebral abscess formation

Treatment and prognosis

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

~~See also~~

~~sinonasal disease~~
~~sinusitis~~

~~acute sinusitis~~

~~chronic sinusitis~~

~~allergic fungal sinusitis~~

-<p><strong>Acute sinusitis</strong> is an acute inflammation of the nasal and paranasal sinus mucosa that last less than four weeks and can occur in any of the <a href="/articles/paranasal-sinuses">paranasal sinuses</a>.</p><h4>Clinical presentation</h4><p>Fever, headache, postnasal discharge of thick sputum, nasal congestion and abnormal smell.</p><h4>Pathology</h4><h5>Aetiology</h5><p>Usually following viral upper respiratory tract infection. Tooth caries, <a href="/articles/dental-abscess">periapical abscess</a> and <a href="/articles/oroantral-fistulation">oroantral fistulation</a> lead to a spread of infection to the maxillary sinus. <a href="/articles/cystic-fibrosis">Cystic fibrosis</a> and allergy are risk factors.</p><p>Other anatomical variants that may predispose to the inflammation include <a href="/articles/deviated-nasal-septum">nasal septal deviation</a>, spur and/or frontoethmoidal recess variants.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Opacification of the sinuses and air/fluid level best seen in the maxillary sinus. Cannot assess the extent of inflammation and its complications.</p><h5>CT</h5><p>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 <a href="/articles/ostiomeatal-complex">ostiomeatal complexes</a> are recognised findings.</p><h5>MRI</h5><p><a href="/articles/t1-weighted-image">T1WI</a> can differentiate between the mucosal thickening that is isointense to soft tissue and fluid that is hypointense. They are both hyperintense in <a href="/articles/t2-weighted-image">T2WI</a>. Inflamed mucosa enhances in post-contrast study while the fluid does not.</p><h4>Complications</h4><ul>
+<p><strong>Acute sinusitis</strong> is an acute inflammation of the nasal and paranasal sinus mucosa that last less than four weeks and can occur in any of the <a href="/articles/paranasal-sinuses">paranasal sinuses</a>.</p><h4>Clinical presentation</h4><p>Fever, headache, postnasal discharge of thick sputum, nasal congestion and abnormal smell.</p><h4>Pathology</h4><h5>Aetiology</h5><p>Usually following viral upper respiratory tract infection. <a title="Dental caries" href="/articles/dental-caries">Dental caries</a>, <a href="/articles/dental-abscess">periapical abscess</a> and <a href="/articles/oroantral-fistulation">oroantral fistulation</a> lead to a spread of infection to the maxillary sinus. <a href="/articles/cystic-fibrosis">Cystic fibrosis</a> and allergy are risk factors.</p><p>Other anatomical variants that may predispose to the inflammation include <a href="/articles/deviated-nasal-septum">nasal septal deviation</a>, spur and/or frontoethmoidal recess variants.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Opacification of the sinuses and air/fluid level best seen in the maxillary sinus. Cannot assess the extent of inflammation and its complications.</p><h5>CT</h5><p>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 <a href="/articles/ostiomeatal-complex">ostiomeatal complexes</a> are recognised findings.</p><h5>MRI</h5><p><a href="/articles/t1-weighted-image">T1WI</a> can differentiate between the mucosal thickening that is isointense to soft tissue and fluid that is hypointense. They are both hyperintense in <a href="/articles/t2-weighted-image">T2WI</a>. Inflamed mucosa enhances in post-contrast study while the fluid does not.</p><h4>Complications</h4><ul>
-</ul><h4>Treatment and prognosis</h4><p>Conservative medical treatment until the inflammation subsides and treatment of the cause, e.g. dental caries. If becomes chronic sinusitis, <a title="Functional endoscopic sinus surgery" href="/articles/functional-endoscopic-sinus-surgery-1">functional endoscopic sinus surgery</a> may be considered.</p><h4>See also</h4><ul><li>
~~-<a href="/articles/sinonasal-disease">sinonasal disease</a><ul><li>~~
~~-<a href="/articles/sinusitis">sinusitis</a><ul>~~
~~-<li><strong>acute sinusitis</strong></li>~~
~~-<li><a href="/articles/chronic-sinusitis">chronic sinusitis</a></li>~~
~~-<li><a href="/articles/allergic-fungal-sinusitis">allergic fungal sinusitis</a></li>~~
~~-</ul>~~
~~-</li></ul>~~
~~-</li></ul>~~
+</ul><h4>Treatment and prognosis</h4><p>Conservative medical treatment until the inflammation subsides and treatment of the cause, e.g. dental caries. If becomes chronic sinusitis, <a href="/articles/functional-endoscopic-sinus-surgery-1">functional endoscopic sinus surgery</a> may be considered.</p>

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