Complications by anatomic compartments involved: — Orbital complications: Up to 75% of complications — Intracranial complications: Up to 20% of complications — Surrounding tissues (Frontal scalp, pre and post maxillary fat, infratemporal and pterygopalatine fossa)
Complications intracranial: Subtle pneumocephalus may be only sign — Meningitis — Epidural abscess or empyema is most common complication arising from middle ear or mastoid infection or subdural abscess — Cerebritis or cerebral abscess — Infarction: Venous thrombosis, angioinvasive disease or infarction, pseudoaneurysm — Pott Puffy tumor — Acute mastoiditis and coalescent mastoiditis — Bezold abscess: Subperiosteal abscess and phlegmonous debris in soft tissues of neck — Superior ophthalmic vein thrombosis and cavernous sinus thrombosis — Venous sinus thrombosis
Treatment: Antibiotics, possible surgical drainage
Clinical:
Radiology Cases of Sinusitis
Radiology Cases of Sinusitis
Waters radiograph of the sinuses shows mucosal thickening and opacification of the bilateral maxillary sinuses, left greater than right.
Radiology Cases of Sinusitis with Orbital Cellulitis
Axial CT with contrast of the orbits shows opacification of the bilateral ethmoid and maxillary sinuses along with pre and post-septal inflammation of the right orbit. No subperiosteal abscess was seen.
Radiology Cases of Sinusitis with Subperiosteal Abscess
Axial CT with contrast of the orbits shows opacification of the left ethmoid sinus and bilateral sphenoid sinuses along with pre and post-septal inflammation of the left orbit. A lenticular fluid collection with rim enhancement is present along the medial wall of the left orbit.Axial CT with contrast of the orbits (above) shows opacification of the ethmoid sinuses and sphenoid sinus along with right preseptal soft tissue swelling. There is a fluid collection with rim enhancment medially next to the wall of the right ethmoid sinus which is better seen on the coronal CT (below).
Axial CT with contrast of the orbits (above) shows opacification of the right ethmoid sinus, inflammatory changes within the right orbit, and a low density oval fluid collection with an enhancing wall between the right medial rectus muscle and the right ethmoid sinus. Coronal CT (below) shows how this fluid collection is displacing the right medial rectus muscle laterally.
Radiology Cases of Sinusitis with Intracranial Abscess
Axial T2 MRI of the brain (above left) shows a mass in the right front lobe with surrounding vasogenic edema. Axial (above right) and coronal (below right) T1 MRI with contrast shows the mass to have thin rim enhancement and the coronal image also shows left maxillary sinusitis. The mass is shown to demonstrate diffusion restriction on diffusion-weighted imaging (below left).
Radiology Cases of Sinusitis with Pott Puffy Tumor with Epidural Empyema
Sagittal CT with contrast of the brain shows frontal and left maxillary sinusitis and extensive soft tissue swelling anterior to the forehead (upper left) and destruction of the anterior left frontal bone in the frontal sinus and extensive soft tissue swelling anterior to the left orbit (upper right). Coronal (lower left) and sagittal (lower right) T1 MRI with contrast of the brain shows diffuse meningeal enhancement, subdural empyemas along the falx and both cerebral convexities, and multiple large non-enhancing subgaleal fluid collections in the left scalp.
Radiology Cases of Sinusitis with Subdural Empyema
Axial (above left and above middle) and coronal (above right) T1 MRI with contrast of the brain shows opacification and rim enhancement of the left ethmoid and frontal sinuses, diffuse enhancement of the left meninges, and subdural fluid collections along the left convexity and falx posteriorly. Axial diffusion weighted (lower left) and ADC (lower right) images show diffuse restriction in the left frontal sinus and parafalcine subdural fluid collections.
