Comparison of B-mode ultasound and computed tomography in the diagnosis ofmaxillary sinusitis in mechanically ventilated patients

Objective: To compare B-mode ultrasound with sinus computed tomograph (GT) scan in the diagnosis of sinusitis in intubated patients undergoing mechani cal ventilation. Design: Prospective, clinical investigation. Setting: Medical intensive care unit of a university hospital. Patients: Fifty patients undergoing intubation and mechanical Ventilation m ore than 2 days, with a clinical suspicion of paranasal sinusitis with puru lent nasal discharge. Interventions: One hundred paranasal sinuses were examined, A paranasal GT scan and a B-mode ultrasound were performed the same day. Radiologic maxill ary sinusitis (RMS) was defined as complete opacification of the sinus or a s the presence of an air-fluid level, Absence of RMS was defined as normal sinus or as the presence of mucosal thickening. Important RMS was defined b y total opacity or air-fluid level larger than half of the sinus area. Mode rate RMS was defined by air-fluid lever inferior than half of the sinus are a. Far ultrasonographic procedure, the image defined as normal was an acous tic shadow arising from the front wall. Two levels of positive echography w ere described: 1) a moderate lesion was defined as the visualization only o f the hyperechogenic posterior wall of the sinus; 2) an important lesion wa s defined as the hyperechogenic visualization of posterior wall and the ext ension by the internal wall of the sinus outlining the hypoechogenic sinus cavity. Measurements and Main Results: Sensibility, specificity, positive predictiv e value, and negative predictive Value of B-mode ultrasound compared with C T were, respectively: 100% (95% confidence intervals [95% CI] = 94.9-100.0) , 96.7% (95% CI = 82.8-99.9), 98.6% (95% CI = 92.4-99.9), and 100% (95% CI = 88.1-100). The concordance between a moderate B-mode ultrasound lesion an d a moderate RMS on CT, and between an important B-mode ultrasound lesion a nd an important RMS on GT, assessed using kappa statistics was 93%. The con cordance between B-mode ultrasound's results and CT's results assessed usin g weighted kappa statistics was 97%. Conclusion: B-mode ultrasound may be proposed first-line in a ventilated pa tient with suspicion of maxillary sinusitis.