Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis

Abstract

Acute bacterial rhinosinusitis frequently evolves from a viral upper respiratory infection (URI). Of all children seeking medical attention for respiratory symptoms, 6 % -7 % have acute bacterial rhinosinusitis [ 1 ]. The most common bacterial agents causing this infection are streptococcus pneumoniae, haemophilus influenza and moxarella catarrhalis. Early identification of children with complications of acute bacterial rhinosinusitis is crucial since it can cause life-threatening illness by the spread of infection to the orbits and central nervous system. In clinical practice, orbital complications are encountered most frequently [ 2 ]. These typically occur in otherwise healthy young children (age < 5 years) presenting with acute ethmoiditis. If left untreated, orbital complications can result in permanent blindness of the affected side [ 3 ]. Clinical symptoms include a swollen eye with or without proptosis or impaired function of the extraocular muscles (i.e. gaze impairment). Intracranial complications are less common but have a higher morbidity and mortality rate [ 1 ]. They typically occur in previously healthy adolescent males presenting with rhinosinusitis in combination with severe headache, photophobia, seizures, or other focal neurologic findings [ 4 ]. If there is clinical suspicion of orbital or intracranial complications, cross-sectional imaging of the orbit and brain is mandatory [ 5 ].