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TESTING – CT Imaging the Sinuses

by Russell A. Faust, PhD, MD

Everyone who has ever had ANY medical test deserves to have at least some understanding of what the test is for and how the results are used. That holds true for sinus x-rays and CT scans.

Here is a short course in “reading” CT scans of your child’s sinuses.

CT Imaging of the Sinuses

Today I will focus on imaging the sinuses. Computed Tomography (CT) Scans.

(I will cover imaging of the neck, and imaging of the ears – along with imaging of the temporal bones, separately at another time).

Important consideration: All test results must be interpreted along with the medical history. A CT scan alone does not determine whether a patient has acute sinusitis, chronic sinusitis, or whether they may need surgery. The whole patient must be considered when reviewing the test results.

How to “Read” a CT Scan: Orientation

The beauty of CT scans is that they can be artificially “rotated” inside the computer. This gives docs the ability to change the angle of the “slices” through the head – the “plane”.

In practical terms, there are only 2 planes that are common for imaging the sinuses: the coronal plane, and the axial plane:

Images of Coronal and Axial Planes

Drawing of Coronal Plane for Sinus Imaging

Above is a drawing of the CORONAL PLANE.

Our view is from the front (ARROW).

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Drawing of Axial Plane for Sinus CT Imaging

Above is a drawing of the AXIAL PLANE.

Our view will be looking up at the slice (ARROW).

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First, some ground rules for “reading” Sinus CT Scans

• white stuff is bone (or teeth)
• black stuff is air
• gray stuff is something else – cheek, brain, eyeball, snot, blood – something else, can’t tell what

Let’s take a look at a few Sinus CT Scans From Patients

Here is a reminder of where the sinuses are:

Image of Face with Sinuses

Sinuses in the Facial Skeleton: Maxillary (M), Ethmoid (E), Frontal

On the drawing above, E denotes Ethmoid Sinuses, and M denotes Maxillary Sinuses.

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CT Scan of Sinuses in the Coronal Plane

CT Scan of Pediatric Sinuses, Coronal Plane

The drawing on the left shows us about where the slice was taken for the CT Scan Image on the right. It goes through the mid or front part of the eye sockets (orbits), ethmoid sinuses, and maxillary sinuses. Compare the CT scan on the right with the drawing of the sinuses and the child’s face just above.

Let’s “Read” The Coronal Sinus CT Scan Above

On the right, the patient is facing us, their right side is on our left and vice versa. Look toward the right side (the patient’s left sinuses): all of the sinuses are black – full of air. That’s a good thing. Now look over at the left side (the patient’s right sinuses): there is some gray stuff in the Maxillary Sinus. Can’t tell exactly what that is, but we can speculate, based on years of experience. Some of it is probably secretions – snot. Some of it is probably swelling. That swelling that goes all the way around the sinus suggests chronic inflammation – chronic sinusitis.

CT Scan of the Sinuses in the Axial Plane

CT Scan of Sinuses in Axial Plane

Let’s “Read” The Axial Sinus CT Scan Above

The drawing at the left shows the level of the slice, below the eye sockets, through the level of the maxillary sinuses. The CT Scan on the right shows the maxillary sinuses full of black – air (arrows). These are relatively healthy sinuses. We are looking up at the slice, so the patient’s right is on our left of the image, and vice versa.

CT Scan of the Sinuses in the Axial Plane

Let’s “Read” The Axial Sinus CT Scan Above

The drawing at the left shows the level of the slice, through the middle of the eye sockets, higher up than the previous scan. The CT Scan on the right shows the ethmoid sinuses, full of black – air (arrows). Again, these are relatively healthy sinuses.

CT Scan of Sinuses in the Coronal Plane

Pediatric Sinusitis - CT Scan, Coronal Plane

Let’s “Read” The Coronal Sinus CT Scan Above

The drawing on the left shows the level of the coronal slice, through the back part of the eye socket. The corresponding CT Scan image on the right shows the ethmoid sinuses, and the maxillary sinuses, nearly full of gray stuff.

In this case, these are nasal and sinus polyps. Only the patient’s right maxillary sinus (on the left of the CT scan) shows a small area of air (black).

This is severe, advanced polyp disease. This can be seen in children with Cystic Fibrosis.

Summary

That should provide the basics to help understand your little boogorhead’s Sinus CT scans. At least, when your ENT doc discusses the findings you can keep up now. For the curious, check out some of the previous articles on this blog about Sinus CT scans, listed below in Resources. Please leave a reply or email me with questions or comments! Thanks for visiting!

More imaging later: I will cover imaging of the neck, and imaging of the ears (and temporal bones) separately at another time.

Over the coming months there will be experts from various areas of medicine here to review the how-and-why of testing. Stay tuned.

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Resources From This Blog:

1. Role of the Beattles in the Invention of the CT Scanner: http://www.whittington.nhs.uk/default.asp?c=2804&t=1
2. 8 Dangerous Complications of Sinusitis, 3 That Can Kill: http://wp.me/pR4iB-57
3. Nasal and Sinus Anatomy, Histology, & Physiology: http://wp.me/pR4iB-1g
4. 3-Year-Old Boy Hospitalized for Severe Chronic Sinusitis: http://wp.me/pR4iB-2k

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Tags: chronic sinusitis, imaging, integrative medicine, medical education, pediatric, pediatric Ear Nose and Throat, pediatric sinusits, rhinosinusitis, sinus anatomy, sinus CT scan, sinusitis