John Yi, Presenter: Nothing to Disclose

Gerald M. Hillman MD, PhD, Abstract Co-Author: Nothing to Disclose

Opacification of or presence of air-fluid levels in paranasal sinuses on head CTs are well known findings seen in association with trauma. When present they serve as a clue to an underlying fracture. Paranasal sinus mucosal thickening on the otherhand is not attributed to injury and often labeled as chronic sinusitis. The goal of this investigation is to determine whether there is an association between paranasal sinus mucosal thickening and trauma.

Approximately 1 week samples of unenhanced head CTs performed during each odd-numbered months of 2003 were reviewed. These samples consisting of 766 patients presenting to one of our institution's ED was generated using the clinical range function on our PACS worklist. Patients were excluded from the investigation if: age>70, presence of NG/ET tube, or suffered major facial fractures. Remaining 668 patients were assigned to "trauma"(mean age 39.01) or "nontrauma"(mean age 44.43) group following review of their clinical records. Their CT examinations were subsequently reviewed. An examination was considered positive for mucosal thickening if it demonstrated uniform circumferential thickening, mucopolypoid thickening, or thickening with fluid in an intact maxillary or the sphenoid sinus. Opacification in frontal or ethmoid sinuses were ignored due to their small size which made them prone to volume averaging and also due to the fact that distinction between fluid and thickening were difficult. Isolated fluid or retension cyst/polyps were ignored.

20.9%(64/309)of trauma group demonstrated paranasal sinus mucosal thickening versus 9.7%(35/359) of nontrauma group. Chi-square 14.95. p-value<0.001.

Increased prevalence of paranasal sinus mucosal thickening is demonstrated in patients presenting following trauma. We postulate that mucosal thickening is a result of trauma rather than due to chronic sunusitis. Further, we speculate that thickening may represent edma or contained submucosal hemorrhage and propose future investigation with other imaging modality such as MRI to further evaluate.

Yi, J, Hillman, G, Prevalence of Paranasal Sinus Mucosal Thickening in Setting of Trauma.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4414612.html