When Should Radiologic Evaluations Be Ordered

Because of the very high incidence of abnormal CT scans in young children,14 a scan cannot rationally be used to determine the need for sinus surgery. Most abnormal CT findings are related to routine (self-limiting) viral and bacterial infections or to postinfectious inflammatory changes that are not related to any particular symptomatology. CT scans, or perhaps other imaging studies, are reasonably ordered with a clinical suspicion of complications (periorbital, intracranial) or in the face of significant symptoms that may be related to sinusitis (e.g., marked worsening of bron-chospasm) without findings specific for sinusitis. Children with abnormal nasal symptoms (e.g, rhinorrhea, congestion) will, in the vast majority of cases, have a scan with abnormal findings. Does one type of CT finding make the patient a better surgical candidate than another set of findings? Some surgeons prefer to consider patients with mucosal disease limited to the OMC, whereas others prefer their surgical candidates to have pansinusitis. If one views sinusitis as a mucosal disease, neither preference makes much sense.

An unbalanced emphasis on CT finding has caused any number of families to focus on those findings as if the CT findings were a disease themselves, regardless patient's clinical status.

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