Incidental Findings in Paranasal Sinuses and Mastoid Cells: A Cross-Sectional Magnetic Resonance Imaging (MRI) Study in a Pediatric Radiology Department

 

 Buy Article Permissions and Reprints

Abstract

Purpose: Misdiagnosis of “sinusitis” is still frequent in children, although mucosal swelling in the paranasal sinuses of children has been reported as a common incidental finding. Recent radiological publications on the problem are rare. We prospectively evaluated the mucosal thickening in the paranasal sinuses and mastoid cells of children who underwent MRI of the head for reasons other than sinusitis or mastoiditis.

Materials and Methods: 147 patients, 0.2 – 22.7 years, median 8.9.  Axial and sagittal T2 TSE images were evaluated by two experienced pediatric radiologists. Categories for the degree of mucosal swelling were for the maxillary, frontal and sphenoid sinuses: no swelling, minor: < 5 mm, or major: ≥ 5 mm; for ethmoid cells and mastoid cells: not present, minor: ≤ 50 % of cells, or major: > 50 %.

Results: 61 % of children had one or more salient findings in their paranasal sinuses or mastoid cells. 48 % had mucosal swelling in their paranasal cavities, 25 % in their mastoid cells. The prevalence was higher among children less than 10 years of age (60 % and 42 %) and among children with current upper respiratory tract infection (71 % and 35 %). There was no correlation to a history of headache, snoring, asthma and allergies, or to gender or place of residence.

Conclusion: Mucosal swelling in paranasal sinuses and in mastoid cells is a frequent incidental finding in children. Even major mucosal swelling in a paranasal sinus is not necessarily a sign of infection. In radiological reports the terms “sinusitis” and “mastoiditis” should therefore be used with great caution. The initiation of treatment should be based on clinical symptoms and not on radiological abnormalities alone.

Zusammenfassung

Ziel: Die Fehldiagnose einer „Sinusitis“ bei Kindern ist immer noch häufig, obwohl Schleimhautschwellungen als häufiger Zufallsbefund in den Nasennebenhöhlen von Kindern bekannt sind. Neuere radiologische Publikationen zu diesem Problem sind selten. Wir untersuchten prospektiv Schleimhautschwellungen in Nasennebenhöhlen und Mastoidzellen von Kindern, die aus anderen Gründen als Sinusitis oder Mastoiditis ein MRT ihres Kopfes erhielten.

Material und Methoden: 147 Patienten, 0,2 – 22,7 Jahre, Median 8,9. Axiale und sagittale T2-TSE-Bilder wurden von 2 erfahrenen Kinderradiologen ausgewertet. Kategorien für das Ausmaß der Schwellung waren in Kiefer-, Stirn- und Keilbeinhöhle: keine Schwellung, geringe: < 5 mm, oder starke: ≥ 5 mm; in den Siebbein- und Mastoidzellen: nicht vorhanden, gering ≤ 50 % der Zellen oder ausgeprägt: > 50 %.

Ergebnisse: 61 % der Kinder hatten einen oder mehrere auffällige Befunde in ihren Nasennebenhöhlen oder Mastoidzellen. 48 % hatten Schleimhautschwellungen in Nebenhöhlen, 25 % in Mastoidzellen. Die Prävalenz war höher bei Kindern unter 10 Jahren (60 % und 42 %) und bei Kindern mit aktuellem Infekt der oberen Luftwege (71 % und 35 %). Es gab keine Korrelation zu anamnestischen Angabe über Kopfschmerzen, nächtlichem Schnarchen, Asthma und Allergien oder zu Geschlecht und Wohnort.

Schlussfolgerung: Schleimhautschwellungen in den Nasennebenhöhlen und in den Mastoidzellen sind häufige Zufallsbefunde bei Kindern. Selbst eine starke Schleimhautschwellung ist nicht notwendigerweise ein Zeichen einer Infektion. In radiologischen Befunden sollten daher die Begriffe „Sinusitis“ und „Mastoiditis“ nur mit äußerster Zurückhaltung verwendet werden. Eine Behandlung sollte nur aufgrund klinischer Symptome und nicht allein aufgrund radiologischer Befunde eingeleitet werden.

• References

• 1 Glasier CM, Mallory GB, Steele RW. Significance of opacification of the maxillary and ethmoid sinuses in infants. J Pediatr 1989; 114: 45-50
  CrossrefPubMedGoogle Scholar
• 2 Bolger WE, Butzin CA, Parsons DS. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for Endoscopic sinus surgery. Laryngoscope 1991; 101: 56-64
  PubMedGoogle Scholar
• 3 Lesserson JA, Kieserman SP, Finn DG. The radiographic incidence of chronic sinus disease in the pediatric population. Laryngoscope 1994; 104: 159-166
  PubMedGoogle Scholar
• 4 Kronemer KA, McAlister WH. Sinusitis and its imaging in the pediatric population. Pediatr Radiol 1997; 27: 837-846
  CrossrefPubMedGoogle Scholar
• 5 Kristo A, Alho OP, Luotonen J et al. Cross-sectional survey of paranasal sinus magnetic resonance imaging findings in schoolchildren. Acta Paediatr 2003; 23: 34-36
  PubMedGoogle Scholar
• 6 Lim WK, Bhaskar R, Fasulakis S et al. Incidental magnetic resonance image sinus abnormalities in asymptomatic Australian children. J Laryngology & Otology 2003; 117: 969-972
  PubMedGoogle Scholar
• 7 Schwedt TJ, Guo Y, Rothner D. “Benign” imaging abnormalities in children and adolescents with headache. Headache 2006; 46: 387-398
  CrossrefPubMedGoogle Scholar
• 8 Balci A, Sangun O, Okuyucu S et al. The prevalence and significance of incidental middle ear and mastoid cavity abnormalities on MRI in a pediatric population. Int J Pediatric Otorhinolaryngology 2008; 72: 1849-1854
  PubMedGoogle Scholar
• 9 Senbil N, Gürer YKY, Üner C et al. Sinusitis in children and adolescents with chronic or recurrent headache: a case control-study. J Headache Pain 2008; 9: 33-36
  CrossrefPubMedGoogle Scholar
• 10 Sultész M, Csákányi Z, Majoros T et al. Acute bacterial rhinosinusitis and its complications in our otolaryngological department between 1997 and 2006. Int J Pediatr Otorhinolaryngol 2009; 73: 1507-1512
  CrossrefPubMedGoogle Scholar
• 11 Reid JR. Complications of pediatric paranasal sinusitis. Pediatr Radiol 2004; 34: 933-942
  CrossrefPubMedGoogle Scholar
• 12 Hegenscheid K, Kühn JP, Völzke H et al. Ganzkörper-Magnetresonanztomographie von gesunden Probanden: Pilotstudienergebnisse der populationsbasierten SHIP Studie. Fortschr Röntgenstr 2009; 181: 748-759
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 Altman DG. Practical Statistics for medical research. 1rst ed. London: Chapman and Hall; 1991
  Google Scholar
• 14 Sachs L. Applied Statistics: A Handbook of Techniques. 5th Ed. (translated by Zenon Reynarowych) New York: Springer-Verlag; 1983
  Google Scholar
• 15 Barghouth G, Prior JO, Lepori D et al. Paranasal sinuses in children: size evaluation of maxillary, sphenoid, and frontal sinuses by magnetic resonance imaging and proposal of volume index percentile curves. Eur Radiol 2002; 12: 1451-1458
  CrossrefPubMedGoogle Scholar
• 16 Kim BS, Illes J, Kaplan RT et al. Incidental findings on Pediatric MR images of the brain. Am J Neuroradiol 2002; 23: 1674-1677
  PubMedGoogle Scholar
• 17 Anzai Y, Paladin A. Diagnostic imaging in 2009: update on evidence-based practice of pediatric imaging. What is the role of imaging in sinusitis?. Pediatr Radiol 2009; 39: S239-S241
  PubMedGoogle Scholar
• 18 Som PM. CT of the paranasal sinuses. Neuroradiology 1985; 27: 189-201
  CrossrefPubMedGoogle Scholar
• 19 Cady RK, Dodock DW, Levine HL et al. Sinus Headache: A neurology, otolaryngology, allergy, and primary care consensus in diagnosis and treatment. Mayo Clin Proc 2005; 80: 908-916
  CrossrefPubMedGoogle Scholar
• 20 Manning SC, Biavati MJ, Phillips DL. Correlation of clinical sinusitis and symptoms to imaging findings in pediatric patients. Int J Pediatr Otorhinolaryngol 1996; 37: 65-74
  CrossrefPubMedGoogle Scholar
• 21 Hill M, Bhattacharyya N, Hall TR et al. Incidental paranasal sinus imaging abnormilities and the normal Lund score in children. Otolaryngol Head neck Surg 2004; 130: 171-175
  CrossrefPubMedGoogle Scholar
• 22 Kristo A, Uhari M, Luotonen J et al. Paranasal sinus findings in children during respiratory infection evaluated with magnetic resonance imaging. Pediatrics 2003; 111: e586-e589
  CrossrefPubMedGoogle Scholar
• 23 Katzman GL, Dagher AP, Patronas NJ. Incidental findings on brain Magnetic Resonance imaging from 1000 asymptomatic Volunteers. JAMA 1999; 281: 36-39
  CrossrefPubMedGoogle Scholar
• 24 Gordts F, Clement PAR, Destryker A et al. Prevalence of sinusitis signs on MRI in a non-ENT pediatric population. Rhinology 1997; 35: 154-157
  PubMedGoogle Scholar
• 25 Schwartz RH, Pitkaranta A, Winther B. Computed tomography imaging of the maxillary and ethmoid sinuses in children with short-duration purulent rhinorrhea. Otolaryngol Head neck Surg 2001; 124: 160-163
  CrossrefPubMedGoogle Scholar
• 26 Gwaltney JM, Phillips CD, Miller RD et al. Computed tomography study of the common cold. N Engl J Med 1994; 330: 25-30
  CrossrefPubMedGoogle Scholar
• 27 Blomgren K, Robinson S, Lönnquist T et al. Clinical significance of incidental magnetic resonance image abnormalities in mastoid cavity and middle ear in children. Int J Pediatr Otolaryngol 2003; 67: 757-760
  CrossrefPubMedGoogle Scholar
• 28 Lee DH, Beom-Cho J, Park JO et al. Magnetic Resonance Imaging of the mastoid cavity and middle ear: Prevalence and clinical significance of incidental abnormal findings in a non otolaryngologic adult and pediatric population. J Otolaryngol 2006; 35: 13-18
  CrossrefPubMedGoogle Scholar
• 29 Sano M, Kaga K, Mima K. MRI findings of the middle ear in infants. Acta OtoLaryngologica 2007; 127: 821-824
  CrossrefPubMedGoogle Scholar
• 30 Meredith JR, Boyev KP. Mastoiditis on MRI: Fact or artifact?. ENT Journal 2008; 87: 514-518
  PubMedGoogle Scholar
• 31 Diamond ML. The role of concomitant headache types and non-headache co-morbidities in the underdiagnosis of migraine. Neurology 2001; 58: S3-S9
  PubMedGoogle Scholar
• 32 Zinreich SJ, Kennedy DW, Kumar AJ et al. MR Imaging of normal nasal cycle: Comparison with sinuspathology. J Comput Assist Tomogr 1988; 12: 1014-1019
  CrossrefPubMedGoogle Scholar
• 33 Herendeen NE, Szilagy PG. Infections of the upper respiratory tract in Nelson’s Textbook of Pediatrics. Behrman et al. (ed.), 16th ed. Philadelphia: WB Saunders; 2000: 1261
  Google Scholar