MRI may require sedation or general anesthesia in order to be performed in young children [61]. Radiography Paranasal Sinuses Radiography is not sensitive for the relatively subtle soft-tissue changes or vascular complications related to the intraorbital or intracranial extension of sinusitis. Variant 4: Child. Suspected invasive fungal sinusitis. Initial imaging. CT Paranasal Sinuses Immunocompromised children, particularly to development of acute invasive sinusitis, and paranasal sinus CT is more frequently used in this population to rule out the source of infection. If clinical suspicion for complicated sinusitis exists, CT with IV contrast of the sinuses to include the orbits and brain is indicated [23,65]. A reported benefit of contrast-enhanced CT for detection of sinusitis-related complications is its significantly shorter scan time, decreasing the need for sedation or general anesthesia in young children. CT of the paranasal sinuses without and with contrast is not recommended as it doubles the radiation exposure without additional significant diagnostic yield. Fungal sinusitis can be correctly diagnosed on CT with high accuracy [67,68]. Obliteration of the normal fat density within the periantral regions, osseous erosion, orbital, cavernous sinus, or brain involvement in an immunocompromised individual should raise the possibility of acute invasive fungal sinusitis [69]. CT Venography Head When clinical or imaging findings point to potential vascular complications of sinusitis (mycotic aneurysm, venous thrombosis), CTV can be performed, either as follow-up studies or as part of the initial CT imaging protocol. CTV is not recommended as a stand-alone study but rather a complementary examination to standard head and sinus CT because other potential complications may be missed when only CTV is used.
Sinusitis Child. MRI may require sedation or general anesthesia in order to be performed in young children [61]. Radiography Paranasal Sinuses Radiography is not sensitive for the relatively subtle soft-tissue changes or vascular complications related to the intraorbital or intracranial extension of sinusitis. Variant 4: Child. Suspected invasive fungal sinusitis. Initial imaging. CT Paranasal Sinuses Immunocompromised children, particularly to development of acute invasive sinusitis, and paranasal sinus CT is more frequently used in this population to rule out the source of infection. If clinical suspicion for complicated sinusitis exists, CT with IV contrast of the sinuses to include the orbits and brain is indicated [23,65]. A reported benefit of contrast-enhanced CT for detection of sinusitis-related complications is its significantly shorter scan time, decreasing the need for sedation or general anesthesia in young children. CT of the paranasal sinuses without and with contrast is not recommended as it doubles the radiation exposure without additional significant diagnostic yield. Fungal sinusitis can be correctly diagnosed on CT with high accuracy [67,68]. Obliteration of the normal fat density within the periantral regions, osseous erosion, orbital, cavernous sinus, or brain involvement in an immunocompromised individual should raise the possibility of acute invasive fungal sinusitis [69]. CT Venography Head When clinical or imaging findings point to potential vascular complications of sinusitis (mycotic aneurysm, venous thrombosis), CTV can be performed, either as follow-up studies or as part of the initial CT imaging protocol. CTV is not recommended as a stand-alone study but rather a complementary examination to standard head and sinus CT because other potential complications may be missed when only CTV is used.