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

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.

Key words

paranasal sinuses - mastoid - mucosal swelling - MRI - incidental finding - children

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