Fact-sheet: Sinusitis ou ethmoiditis
Updated on 09/17/2021 at 12:16 PM
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Definition
Bacterial infection of the ethmoidal labyrinth cells
Mainly affects young children
Clinical features
Clinical diagnosis: -Edema of the medial canthus, upper eyelid edema -Nasal obstruction, rhinorrhea -Fever Good prognosis if confined to the preseptal space Risk of spread to the orbital cavity, posterior intracranial extension Functional and vital risk if retroseptal extension: Exophthalmos Oculomotor paralysis Decreased visual acuity
Laboratory findings
inflammatory syndrome
Ultrasound
Indicated for the workup of intraorbital abscess!
CT
Indications for contrast-enhanced CT (or MRI if available): -Suspected complicated ethmoiditis with intraorbital involvement -Chandler stage >or=3: Impaired ocular motility -Decreased visual acuity, diplopia -Non-reducible exophthalmos In practice, it is preferable to obtain a CT scan rather than miss the diagnosis of retro-septal involvement, but the CT must be performed under proper conditions, i.e., with iodinated contrast ++ -Isolated chemosis is not an indication CT features: -Infiltration of the medial canthus without intraorbital involvement (pre-septal ethmoiditis) -Opacification of the ethmoidal cells -Bone lysis involving the ethmoidal labyrinth Complications to look for: -Subperiosteal intraorbital abscess: splitting of the medial orbital wall, displacement of the orbital cone, and exophthalmos -Abscess of brain -Subdural empyema -Cavernous sinus thrombophlebitis
Management
Treatment: -Simple ethmoiditis: intravenous antibiotic therapy -Collection: warrants image-guided surgical drainage.