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Complications of Rhinosinusitis
Nicholas A. Koontz, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Rhinosinusitis (RS)
            • Definitions

              • Complications of acute rhinosinusitis (ARS) or chronic rhinosinusitis (CRS) may affect bone & overlying soft tissues, orbit, or intracranial cavity
                • Superficial complications: Osteomyelitis, subgaleal abscess (Pott puffy tumor), septic thrombophlebitis
                • Orbital complications: Preseptal cellulitis/abscess, subperiosteal postseptal abscess (SPA), myositis of extraocular muscles, optic neuritis, septic thrombophlebitis
                • Intracranial complications: Meningitis, epidural abscess (EDA), subdural empyema (SDE), cerebritis, brain abscess, cavernous sinus thrombosis (CST)

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Snidvongs K et al: Risk factors of orbital complications in outpatients presenting with severe rhinosinusitis: a case-control study. Clin Otolaryngol. 46(3):587-93, 2021
                                      2. Thompson HM et al: Treatment of frontal sinus osteomyelitis in the age of endoscopy. Am J Rhinol Allergy. 35(3):368-74, 2021
                                      3. Kim BY et al: Characteristics of atypical orbital complications of sinusitis. J Craniofac Surg. 31(5):e435-9, 2020
                                      4. Marchiano E et al: Characteristics of patients treated for orbital cellulitis: an analysis of inpatient data. Laryngoscope. 126(3):554-9, 2016
                                      5. Padia R et al: Hospital cost of pediatric patients with complicated acute sinusitis. Int J Pediatr Otorhinolaryngol. 80:17-20, 2016
                                      6. Vázquez A et al: Overview of frontal sinus pathology and management. Otolaryngol Clin North Am. 49(4):899-910, 2016
                                      7. Benevides GN et al: Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome. Autops Case Rep. 5(4):19-26, 2015
                                      8. Cotes C et al: Facial vein thrombophlebitis: an uncommon complication of sinusitis. Pediatr Radiol. 45(8):1244-8, 2015
                                      9. Dankbaar JW et al: Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging. 6(5):509-18, 2015
                                      10. Fang A et al: Pediatric acute bacterial sinusitis: diagnostic and treatment dilemmas. Pediatr Emerg Care. 31(11):789-94; quiz 795-7, 2015
                                      11. Lizé F et al: Septic cavernous sinus thrombosis secondary to acute bacterial sinusitis: A retrospective study of seven cases. Am J Rhinol Allergy. 29(1):7-12, 2015
                                      12. Patel AP et al: Management and outcomes in children with sinogenic intracranial abscesses. Int J Pediatr Otorhinolaryngol. 79(6):868-73, 2015
                                      13. Sharma S et al: Orbital complications of acute sinusitis in infants: a systematic review and report of a case. JAMA Otolaryngol Head Neck Surg. 140(11):1070-3, 2014
                                      14. Cornelius RS et al: ACR appropriateness criteria sinonasal disease. J Am Coll Radiol. 10(4):241-6, 2013
                                      15. Hegde AN et al: Imaging in infections of the head and neck. Neuroimaging Clin N Am. 22(4):727-54, 2012
                                      16. Bayonne E et al: Intracranial complications of rhinosinusitis. A review, typical imaging data and algorithm of management. Rhinology. 47(1):59-65, 2009
                                      17. Coenraad S et al: Surgical or medical management of subperiosteal orbital abscess in children: a critical appraisal of the literature. Rhinology. 47(1):18-23, 2009
                                      18. Mittal MK et al: Meningitis and epidural abscess related to pansinusitis. Pediatr Emerg Care. 25(4):267-8, 2009
                                      19. Betz CS et al: Complications of acute frontal sinusitis: a retrospective study. Eur Arch Otorhinolaryngol. 265(1):63-72, 2008
                                      20. Eviatar E et al: Conservative treatment in rhinosinusitis orbital complications in children aged 2 years and younger. Rhinology. 46(4):334-7, 2008
                                      21. Wu VF et al: Sinocutaneous fistula secondary to chronic frontal rhinosinusitis: case series and literature review. Ann Otol Rhinol Laryngol. 117(10):759-63, 2008
                                      22. Kombogiorgas D et al: Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. Br J Neurosurg. 21(6):603-9, 2007
                                      23. Osborn MK et al: Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 7(1):62-7, 2007
                                      24. Velasco e Cruz AA et al: Orbital complications of acute rhinosinusitis: a new classification. Braz J Otorhinolaryngol. 73(5):684-8, 2007
                                      25. Germiller JA et al: Intracranial complications of sinusitis in children and adolescents and their outcomes. Arch Otolaryngol Head Neck Surg. 132(9):969-76, 2006
                                      26. Glickstein JS et al: Intracranial complications of pediatric sinusitis. Otolaryngol Head Neck Surg. 134(5):733-6, 2006
                                      27. Herrmann BW et al: Intracranial complications of pediatric frontal rhinosinusitis. Am J Rhinol. 20(3):320-4, 2006
                                      28. Mafee MF et al: Imaging of rhinosinusitis and its complications: plain film, CT, and MRI. Clin Rev Allergy Immunol. 30(3):165-86, 2006
                                      29. Jackson LL et al: Classification and management of rhinosinusitis and its complications. Otolaryngol Clin North Am. 38(6):1143-53, 2005
                                      30. Oxford LE et al: Complications of acute sinusitis in children. Otolaryngol Head Neck Surg. 133(1):32-7, 2005
                                      31. Wong AM et al: Magnetic resonance imaging of carotid artery abnormalities in patients with sphenoid sinusitis. Neuroradiology. 46(1):54-9, 2004
                                      32. Younis RT et al: The role of computed tomography and magnetic resonance imaging in patients with sinusitis with complications. Laryngoscope. 112(2):224-9, 2002
                                      33. Eustis HS et al: MR imaging and CT of orbital infections and complications in acute rhinosinusitis. Radiol Clin North Am. 36(6):1165-83, xi, 1998
                                      34. Schuknecht B et al: Tributary venosinus occlusion and septic cavernous sinus thrombosis: CT and MR findings. AJNR Am J Neuroradiol. 19(4):617-26, 1998
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Rhinosinusitis (RS)
                                                • Definitions

                                                  • Complications of acute rhinosinusitis (ARS) or chronic rhinosinusitis (CRS) may affect bone & overlying soft tissues, orbit, or intracranial cavity
                                                    • Superficial complications: Osteomyelitis, subgaleal abscess (Pott puffy tumor), septic thrombophlebitis
                                                    • Orbital complications: Preseptal cellulitis/abscess, subperiosteal postseptal abscess (SPA), myositis of extraocular muscles, optic neuritis, septic thrombophlebitis
                                                    • Intracranial complications: Meningitis, epidural abscess (EDA), subdural empyema (SDE), cerebritis, brain abscess, cavernous sinus thrombosis (CST)

                                                IMAGING

                                                • General Features

                                                  • CT Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Snidvongs K et al: Risk factors of orbital complications in outpatients presenting with severe rhinosinusitis: a case-control study. Clin Otolaryngol. 46(3):587-93, 2021
                                                                          2. Thompson HM et al: Treatment of frontal sinus osteomyelitis in the age of endoscopy. Am J Rhinol Allergy. 35(3):368-74, 2021
                                                                          3. Kim BY et al: Characteristics of atypical orbital complications of sinusitis. J Craniofac Surg. 31(5):e435-9, 2020
                                                                          4. Marchiano E et al: Characteristics of patients treated for orbital cellulitis: an analysis of inpatient data. Laryngoscope. 126(3):554-9, 2016
                                                                          5. Padia R et al: Hospital cost of pediatric patients with complicated acute sinusitis. Int J Pediatr Otorhinolaryngol. 80:17-20, 2016
                                                                          6. Vázquez A et al: Overview of frontal sinus pathology and management. Otolaryngol Clin North Am. 49(4):899-910, 2016
                                                                          7. Benevides GN et al: Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome. Autops Case Rep. 5(4):19-26, 2015
                                                                          8. Cotes C et al: Facial vein thrombophlebitis: an uncommon complication of sinusitis. Pediatr Radiol. 45(8):1244-8, 2015
                                                                          9. Dankbaar JW et al: Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis. Insights Imaging. 6(5):509-18, 2015
                                                                          10. Fang A et al: Pediatric acute bacterial sinusitis: diagnostic and treatment dilemmas. Pediatr Emerg Care. 31(11):789-94; quiz 795-7, 2015
                                                                          11. Lizé F et al: Septic cavernous sinus thrombosis secondary to acute bacterial sinusitis: A retrospective study of seven cases. Am J Rhinol Allergy. 29(1):7-12, 2015
                                                                          12. Patel AP et al: Management and outcomes in children with sinogenic intracranial abscesses. Int J Pediatr Otorhinolaryngol. 79(6):868-73, 2015
                                                                          13. Sharma S et al: Orbital complications of acute sinusitis in infants: a systematic review and report of a case. JAMA Otolaryngol Head Neck Surg. 140(11):1070-3, 2014
                                                                          14. Cornelius RS et al: ACR appropriateness criteria sinonasal disease. J Am Coll Radiol. 10(4):241-6, 2013
                                                                          15. Hegde AN et al: Imaging in infections of the head and neck. Neuroimaging Clin N Am. 22(4):727-54, 2012
                                                                          16. Bayonne E et al: Intracranial complications of rhinosinusitis. A review, typical imaging data and algorithm of management. Rhinology. 47(1):59-65, 2009
                                                                          17. Coenraad S et al: Surgical or medical management of subperiosteal orbital abscess in children: a critical appraisal of the literature. Rhinology. 47(1):18-23, 2009
                                                                          18. Mittal MK et al: Meningitis and epidural abscess related to pansinusitis. Pediatr Emerg Care. 25(4):267-8, 2009
                                                                          19. Betz CS et al: Complications of acute frontal sinusitis: a retrospective study. Eur Arch Otorhinolaryngol. 265(1):63-72, 2008
                                                                          20. Eviatar E et al: Conservative treatment in rhinosinusitis orbital complications in children aged 2 years and younger. Rhinology. 46(4):334-7, 2008
                                                                          21. Wu VF et al: Sinocutaneous fistula secondary to chronic frontal rhinosinusitis: case series and literature review. Ann Otol Rhinol Laryngol. 117(10):759-63, 2008
                                                                          22. Kombogiorgas D et al: Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. Br J Neurosurg. 21(6):603-9, 2007
                                                                          23. Osborn MK et al: Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 7(1):62-7, 2007
                                                                          24. Velasco e Cruz AA et al: Orbital complications of acute rhinosinusitis: a new classification. Braz J Otorhinolaryngol. 73(5):684-8, 2007
                                                                          25. Germiller JA et al: Intracranial complications of sinusitis in children and adolescents and their outcomes. Arch Otolaryngol Head Neck Surg. 132(9):969-76, 2006
                                                                          26. Glickstein JS et al: Intracranial complications of pediatric sinusitis. Otolaryngol Head Neck Surg. 134(5):733-6, 2006
                                                                          27. Herrmann BW et al: Intracranial complications of pediatric frontal rhinosinusitis. Am J Rhinol. 20(3):320-4, 2006
                                                                          28. Mafee MF et al: Imaging of rhinosinusitis and its complications: plain film, CT, and MRI. Clin Rev Allergy Immunol. 30(3):165-86, 2006
                                                                          29. Jackson LL et al: Classification and management of rhinosinusitis and its complications. Otolaryngol Clin North Am. 38(6):1143-53, 2005
                                                                          30. Oxford LE et al: Complications of acute sinusitis in children. Otolaryngol Head Neck Surg. 133(1):32-7, 2005
                                                                          31. Wong AM et al: Magnetic resonance imaging of carotid artery abnormalities in patients with sphenoid sinusitis. Neuroradiology. 46(1):54-9, 2004
                                                                          32. Younis RT et al: The role of computed tomography and magnetic resonance imaging in patients with sinusitis with complications. Laryngoscope. 112(2):224-9, 2002
                                                                          33. Eustis HS et al: MR imaging and CT of orbital infections and complications in acute rhinosinusitis. Radiol Clin North Am. 36(6):1165-83, xi, 1998
                                                                          34. Schuknecht B et al: Tributary venosinus occlusion and septic cavernous sinus thrombosis: CT and MR findings. AJNR Am J Neuroradiol. 19(4):617-26, 1998