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

Abstract

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.

Comparison of MR imaging findings in paediatric and adult patients with acute mastoiditis and incidental intramastoid bright signal on T2-weighted images

“…Our results of an overall frequency of 21.8 % for incidental mastoid T2-hyperintensity are similar to those obtained by previous studies [7,8,15]. The frequency of pronounced (≥50 %) mastoid opacification was much lower in our data, at only 4.8 %.…”

“…The reported frequency of intramastoid T2 hyperintensity varies but is higher for children (12-27 %) than for adults (5 %) [7][8][9]15].…”

“…Intramastoid T2 hyperintensity-although half as frequent as incidental mucosal swelling in paranasal sinuses-is a relatively common finding in MR imaging [9,15]. The reported frequency of intramastoid T2 hyperintensity varies but is higher for children (12-27 %) than for adults (5 %) [7][8][9]15].…”

“…Correlations between mastoid T2-hyperintensity and clinical history or signs of otitis media are controversial; stronger associations to clinically relevant disease have been reported in adults [7][8][9]15]. Intramastoid bright signal on T2-WI has been shown to be a source of AM misdiagnosis by radiologists, potentially leading to unnecessary investigations or treatment [10,11].…”

Documento de consenso sobre etiología, diagnóstico y tratamiento de la sinusitis

“…It is worse than CT at demonstrating the bony structure of the osteomeatal complex, and it also shows abnormalities in patients with a common cold 40 , although it is more sensitive in the early detection of intracranial complications, in the differentiation between inflammation and tumours, and in cases of chronic fungal sinusitis, which is very rare in children 41 .…”