eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Nasal & Sinus Diseases

Sinusitis, Sphenoid, Acute, Surgical Treatment: Workup

Author: Rami K Batniji, MD, Private Practice, Batniji Facial Plastic Surgery
Coauthor(s): Michelle S Marrinan, MD, Staff Physician, Department of Otolaryngology, Montefiore Medical Center, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Jan 2, 2009

Workup

Laboratory Studies

  • Include WBC count and differential in the laboratory evaluation. Findings of leukocytosis with a left shift suggest acute infection.
  • Blood cultures may help identify a pathogen.
  • Perform a lumbar puncture if meningitis is suggested.

Imaging Studies

  • CT scan
    • In the workup of a patient with suggested sphenoid sinusitis, imaging studies are the mainstay of diagnosis. CT scan establishes the presence of sphenoid disease and provides information on bony erosion. An air-fluid level is usually observed in acute disease, while complete opacification is more common in chronic disease. A globular opacity filling the cavity is likely to be a retention cyst or polyp; however, further studies may be needed to rule out a rare encephalocele or aneurysm.
    • In the setting of acute sinusitis, a CT scan establishes the anatomy of the sphenoid, including the size of the cavity and the intersinus septum. The presence of pansinusitis can be determined. Identify the internal carotid artery, pituitary, and optic nerve.
  • MRI
    • MRI is useful in evaluating the relationship of the sphenoid to its surrounding structures. Although CT scanning is useful in showing bony erosion, MRI is better for imaging of soft tissues. Several CT scanning findings require further workup with MRI. Bony erosion requires an MRI to differentiate mucoceles from tumors. An image with low density on T1 images and high density on T2 is characteristic of a mucocele. Tumors tend to show intermediate density in T1 and T2 images. Fungal sinusitis can be identified by signal voids within the sinus. A mixed signal pattern, in contrast, is typical of fibroosseous orders. Any extrasinus extension in conjunction with bony erosion is likely to be a malignancy. Partial opacification of the sphenoid may occasionally represent an internal carotid artery aneurysm or encephalocele.
    • In the setting of acute sphenoid sinusitis, MRI is valuable in evaluating patients with neurologic or visual complaints for evidence of complications. The structures surrounding the sphenoid (eg, dura, optic nerve, cavernous sinus) are demonstrated. Cavernous sinus thrombosis, in particular, can be identified.
  • Magnetic resonance angiography (MRA) can be used to confirm the diagnosis of cavernous sinus thrombosis.

More on Sinusitis, Sphenoid, Acute, Surgical Treatment

Overview: Sinusitis, Sphenoid, Acute, Surgical Treatment
Workup: Sinusitis, Sphenoid, Acute, Surgical Treatment
Treatment: Sinusitis, Sphenoid, Acute, Surgical Treatment
Follow-up: Sinusitis, Sphenoid, Acute, Surgical Treatment
References
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References

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Further Reading

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Keywords

sphenoid, sinusitis, acute sphenoiditis, sphenoid sinusitis, acute sinusitis, acute sphenoid sinusitis, sinus infection sphenoid

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Contributor Information and Disclosures

Author

Rami K Batniji, MD, Private Practice, Batniji Facial Plastic Surgery
Rami K Batniji, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, California Medical Association, and Triological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Michelle S Marrinan, MD, Staff Physician, Department of Otolaryngology, Montefiore Medical Center, Albert Einstein College of Medicine
Michelle S Marrinan, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jack A Coleman, MD, Consulting Staff, Franklin Surgical Associates
Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society for Laser Medicine and Surgery, and Association of Military Surgeons of the US
Disclosure: Influent  None Review panel membership; accarent, inc Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists
Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
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