SINUSITIS AND INTRACRANIAL SEPSIS - THE CT IMAGING AND CLINICAL PRESENTATION

The CT imaging and clinical presentation in 14 children with coexisten t intracranial sepsis and sinusitis were reviewed, A routine CT head s can (10-mm thick semi-axial slices through the cranium done before and after intravenous contrast medium administration) was found to be an inadequate initial investigation as the intracranial collection was mi ssed in four patients and the abnormal sinuses not shown in six. In ha lf the children the diagnosis of sinusitis was unsuspected at the time of admission. The dominant clinical features were fever, intense head ache and facial swelling in early adolescent males. In this clinical s etting we recommend: (1) the routine scan is extended through the fron tal and ethmoidal sinuses and photographed at a window level and width showing both bone detail and air/soft tissue interfaces; (2) direct c oronal projections are performed through the anterior cranial fossa if no collection is seen on the routine study; (3) an early repeat scan within 48 h if the initial study shows no intracranial pathology but t he fronto-ethmoidal sinuses are abnormal and there is a high clinical suspicion of intracranial sepsis; and (4) in the presence of intracran ial sepsis the vault is viewed at bone window settings to exclude cran ial osteomyelitis.