Adult Chronic Sinusitis and Its Complications

By G. Douglas Campbell Jr., MD, FCCP

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Figure 2. Contiguous CT scans comparing normal (A) and abnormal (B) sphenoid sinuses. Note the total opacification of the sphenoid sinus with marked sclerosis of the sphenoid wall and intersphenoidal sinus septum. This patient had significant polyposis that is not well visualized on CT scan but can be best identified with MRI scanning.

A less costly alternative is noncontiguous coronal CT images. The cost of this approach is reported to be comparable to that of plain films. With this procedure, four noncontiguous coronal CT images are obtained, one from each of the following: (1) the frontal sinuses, (2) the anterior ethmoid and maxillary sinuses, (3) the posterior ethmoid and maxillary sinuses, and (4) the sphenoid sinuses. When these four noncontiguous cuts were retrospectively compared with the standard 2- to 5-mm contiguous coronal CT examination, the overall sensitivity was 93.3% and specificity was 89.3%; however, the findings are of limited value if surgery is being considered.²⁸ Limited CT examination using axial cuts can also be performed and can be helpful because the entire ethmoid complex can be displayed. Use of both axial and coronal CT examination can allow the physician to obtain the most anatomical information. Once rhinosinusitis has been identified, CT scanning does not have to be performed each time the patient presents with similar symptoms.

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