Abnormal paranasal sinuses in patients with cystic fibrosis of the pancreas

Radiographic examinations of the paranasal sinuses and chests of 187 patients with C.F. from five months to 27 years of age were reviewed. One hundred eighty-five patients consistently had opaque maxillary and ethmoidal sinuses. Forty-five patients had normal chest radiographs. These observations show that the paranasal sinuses are almost always affected in children with C.F. Although opaque paranasal sinuses do not indicate the diagnosis of C.F., clear paranasal sinuses exclude this disease with reasonable certainty.     

Midline dermal sinuses and cysts and their relationship to the central nervous system.

Sixty-one children (below 12 years) with midline dermal inclusions of the cranium and spine were operated on at the Red Cross War Memorial Children's Hospital between 1969-1990. The bregmatic area was the most common position for superficial cysts (33). Eight children had sinuses or cysts near the external occipital protuberance, 2 had isolated fourth ventricular cysts and 1 had a cyst in the quadrigeminal plate cistern. Fifteen children had spinal dermal inclusions, 13 of these were in the lumbosacral area, there was 1 sinus in the cervical spine and another in the midthoracic area attached to an intramedullary cyst. Two children had frontal sinuses, one of which was connected to an interhemispheric dermoid cyst and a lipoma of the corpus callosum. A midline swelling or sinus was the most common clinical presentation. Four out of 15 spinal inclusions and 1/11 occipital sinuses had a meningitic history. Five of 11 of the posterior fossa inclusions had raised intracranial pressure and signs suggestive of cerebellar tumor or abscess. Not one of the 33 bregmatic lesions had any connection to the central nervous system. MRI has proved useful in diagnosing both dermal sinuses and cysts, but CT scanning was our standard investigation. Plain x-ray revealed bony abnormalities in only 60% of our patients with spinal sinuses. We feel that all dermal sinuses or cysts in the midline should be surgically explored after CT or MRI scanning. Lesions mistaken for bregmatic cysts have included hemangiomas (4), hamartomas (2), an encephalocele through the anterior fontanelle (1) and lipomas (2).(ABSTRACT TRUNCATED AT 250 WORDS)     

Chronic sinusitis in the allergic child

Chronic inflammation of the paranasal sinuses, especially the maxillary sinuses, is common in children with respiratory allergy. The presence of sinusitis should be suspected in such children when they have chronic night and early morning cough or poorly controlled asthma. Treatment should be aggressive because morbidity can be high.     

Minimally invasive surgery of sinugenic orbital complications in childhood]

Orbital complications of acute sinusitis are classified into inflammatory edema, orbital cellulitis, subperiostal abscess and orbital abscess. The diagnosis is based on endoscopy of the nose, computed tomography of sinuses and orbit and an ophthalmological examination. Endonasal sinus surgery improves drainage and ventilation of sinuses and is free of long-term complications as observed with previous surgical techniques. Thus, the early surgical treatment of orbital complications is indicated even in children. Inflammatory edema and orbital cellulitis will still be treated conservatively. Subperiostal abscess and orbital abscess are treated surgically.     

Calcified cerebral sinus thrombosis in infancy —CT appearances with pathological correlation

A case of calcified cerebral venous sinus thrombosis in an infant is described, with autopsy correlation. Calcification of sinus thrombosis is rare. A triangular calcific density was demonstrated in the superior sagittal sinus, with extension of linear calcification laterally into the transverse sinuses. Following intravenous contrast administration there was intense enhancement of the superior sagittal and transverse sinuses around the calcified thrombus. The cerebral hemispheres showed generalised atrophy. Autopsy confirmed a calcified venous sinus thrombus. Triangular calcium density within the sagittal sinus or linear calcification within the transverse sinuses would appear to be characteristic of calcified cerebral sinus thrombus.     

Imaging techniques in the diagnosis and management of rhinosinusitis in children

Sinusitis in children is a common problem. The diagnosis of both acute and chronic rhinosinusitis in the pediatric population, should be made first of all clinically, and not on the basis of imaging findings alone. Plain radiography may be used as a screening method for various pathological conditions of sinuses, but computed tomography (CT) remains the study of choice for the imaging evaluation of acute and chronic rhinosinusitis. In acute sinusitis, CT is indicated in patients with symptoms persisting after 10 days of appropriate therapy and in patients with suspected complications (especially in the brain and in the orbit). In addition to CT scanning, magnetic resonance (MR) imaging of the sinuses, orbits, and brain should be performed whenever extensive or multiple complications of sinusitis are suspected. In chronic sinusitis, CT scanning is the 'gold standard' for the diagnosis and the management, because it also provides an anatomic road map, when surgery is required. Nuclear medicine studies and ultrasound are rarely indicated in acute and chronic rhinosinusitis.     

Comparison of sonographic and roentgenologic findings in the paranasal sinuses in children

Sonography of maxillary sinuses was performed in 362 asymptomatic children with chronic airway diseases, using a 7.5 MHz sector scanner. Pathologic findings were detected in 78 (21.5%) children. Occipito-frontal radiographs of the sinuses were performed in 40 (11%) randomly chosen children and the findings were later compared with those of sonography. An overall agreement in terms of "normal-abnormal" findings was present in 94% of the 80 sinuses examined. In sinuses judged as "normal" or "abnormal" in either of the methods, findings were corresponding as "normal" in 40 of 45 (89%) and as "abnormal" in 35 of 40 (87%) sinuses. A differentiated assessment of pathologic findings showed an agreement in only 19 of 40 (48%) sinuses. Thus, an overall agreement of differentiated findings was present in 59 of 80 (74%) sinuses. Sonography was superior to radiography especially in differentiating the sinus content in secretion, swelling of the mucosa, polyps, cysts and air. In conclusion, sonography offers an accurate screening method for assessment of paranasal sinuses in children.     

Congenital cysts, sinuses and fistula of head and neck]

Congenital cervical cysts, sinuses and fistulae are uncommon malformations. Diagnosis and management of congenital cervical cysts, sinuses and fistulae requires a good understanding of their embryological development and topography. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies and dermoid cysts. In this review, we discuss both the classical and current aspects of these malformations.     

A prospective search for congenital dermal abnormalities of the craniospinal axis.

Nineteen-hundred and ninety-seven consecutive term newborn infants were examined for cutaneous abnormalities of the craniospinal axis. Fifty-eight of the neonates (3%) had one or more abnormalities. The major findings included 28 (1.4%) deep dimples; 23 (1.2%) presumed sinuses; six (0.3%) skin tags,and one nodular mass. Fifty children were seen in follow-up at 4 to 12 months; in 40 infants the initial major finding persisted unchanged. Surgery has been performed on five children. One dermal sinus was found to terminate at the dura, three sinuses terminated at the coccyx, and a skin tag was associated with a fibrous band that extended to the coccyx. The management of congenital dermal sinuses is discussed.     

Transcatheter Closure of Ruptured Sinus of Valsalva Aneurysm Into the Left Ventricle: A Retrograde Approach

Aneurysms of sinuses of Valsalva (ASOV) are thin-walled saccular or tubular outpouchings of the aortic sinuses, which can be either congenital or acquired. They can rupture into heart chambers, the pulmonary artery, or the pericardial space (Perloff, Clinical recognition of congenital heart disease, [8]). This report presents a rare case of a patient with treated infective endocarditis who had a patent ductus arteriosus (PDA), a coronary cameral fistula, and a ruptured ASOV (RASOV) into the left ventricle (LV). Successful transcatheter closure of the ruptured ASOV and the other two lesions was performed using three Amplatzer duct occluders (AGA Medical Corporation, Golden Valley, MN, USA).     

The current management of sinusitis in children.

The paranasal sinuses are common sites of infection in children. The diagnosis of sinusitis may be challenging because the sinus cavities are small and variably contoured, the clinical manifestations are often nonspecific, and the radiologic findings may be equivocal. Because many local and systemic factors contribute to sinusitis in children, the therapeutic regimens vary. In addition to conventional medical approaches, new surgical procedures and improved anesthetic techniques have made functional endonasal sinus surgery an excellent management tool for selected patients with chronic or recurrent disease.     

Does D-dimer predict cerebral sinovenous thrombosis in the newborn?

Sinovenous thrombosis describes thrombosis in one or more of the cerebral venous sinuses. The incidence of SVT in childhood appears to be highest during the neonatal period. Although plasma level of d-dimer has been shown to be sensitive for the diagnosis of deep vein thrombosis and pulmonary embolism in adult patients, there are few data about the relationship between sinovenous thrombosis and d-dimer levels in childhood, especially in the newborn period. The authors' aim in presenting this case report is to discuss the usefulness of plasma d-dimer measurements as a predictor of cerebral sinovenous thrombosis in the newborn.     

Cross-sectional survey of paranasal sinus magnetic resonance imaging findings in schoolchildren

Aim: Sinus image abnormalities are common among children examined for indications other than sinus disease. The purpose of this study was to determine the frequency of sinus abnormalities among otherwise healthy children attending school. Methods: Magnetic resonance imaging (MRI) was performed on 24 children aged 8-9 y, 18 of whom were re-examined after 6-7 mo. Results: Sinus abnormalities were common. An abnormality was seen in 12 of the children [50%, 95% confidence interval (95% CI) 29-71%], and 9 (38%, 95% CI 19-59%) had abnormalities in the maxillary sinuses. As many as 8 (42%, 95% CI 20-67%) of the asymptomatic children (lacking clinical symptoms or findings) had abnormalities in the maxillary or ethmoidal sinuses. The follow-up examination showed that about half of the abnormal sinus MRI findings had resolved or improved without any intervention. Conclusion: Abnormal sinus MRI findings are common both among otherwise healthy children attending school and in totally asymptomatic children. As incidental findings, these should be interpreted as normal and do not indicate any need for treatment in children imaged for purposes other than sinus disease.     

Young boy with multiple periarticular swellings and discharging sinuses: tumoral calcinosis

A young boy with periarticular nodules and discharging sinuses diagnosed as tumoral calcinosis is described. The case is reported to highlight its rarity and low index of suspicion for this disease. Mechanisms of these solid tumours deposits and their management are discussed.     

A large planum sphenoidale meningioma with sinonasal extension in a child. Case report and review of the literature

Anterior cranial base meningiomas are rare tumors in children. Due to the extensive involvement of orbit, paranasal sinuses, midface, and anterior skull base, a multidisciplinary approach is warranted. We present a case of a child with a large planum sphenoidale meningioma extending into subfrontal region, ethmoid and maxillary sinuses inferiorly, and orbits laterally. The patient, a 4-year-old girl, presented with long-standing nasal stuffiness and swelling of the midface. An extended frontobasal approach through a bifrontal craniotomy was used to resect the intracranial portion of this mass. The tumor had eroded through nasal septum, medial orbital walls, and left maxilla, structures which were not readily accessible from a cranial approach alone. A modified Weber-Ferguson incision was used for a transfacial approach to resect the residual mass below the skull base. The advantages of combining the bifrontal craniotomy with a transfacial split provided the added exposure to maximize the extent of resection.     

小儿颅脊柱轴先天性皮肤窦道的外科处理

目的总结小儿颅脊柱轴先天性皮肤窦道的临床特点和诊治经验。方法回顾分析1990年7月-2005年7月经外科手术和病理证实43例。结果本组男24例，女19例，年龄2个月～11岁，平均年龄2．6岁。MRI是主要诊断方法。皮肤窦道位于枕后4例．颈段1例，胸段4例，腰骶段34例。枕后4例窦道穿过硬脑膜，合并小脑皮样囊肿继发脑脓肿，脊柱部位39例中合并皮样囊肿20例，表皮样囊肿2例，5例皮样囊肿位于髓内，其中2例继发感染形成脓肿。囊肿完全摘除17例，残留部分囊肿壁5例。结论颅脊柱轴皮肤窦道为先天性疾病。MRI是首选的诊断手段，早期诊断和显微外科手术治疗是最佳的选择。     

Significance of opacification of the maxillary and ethmoid sinuses in infants

To evaluate the incidence and significance of radiographic sinus opacification in infants, we performed computed tomography (CT) of the maxillary and ethmoid sinuses in conjunction with routine cranial CT in 100 infants from birth to 12 months of age. CT was performed for indications other than sinusitis. Prospective concurrent clinical history was obtained and physical examination of the upper respiratory tract was performed. Of 100 infants, 16 had hypoplasia of the maxillary sinuses; 81% (13/16) of these were less than 2 months of age. The antra showed progressive increase in size during the first year of life. Of the 100 infants, 70 had CT sinus opacification, including 67% of those without historical or physical evidence of upper respiratory tract infection. There was a positive correlation of CT findings between the maxillary and ethmoid sinuses in 80% of the infants older than 2 months of age but in only 49% of the younger infants. Radiographic sinus opacification in infants is of uncertain significance and is not diagnostic of upper respiratory tract infection, much less of sinusitis.     

Congenital bilateral plexiform neurofibromas of the cavernous sinuses

We report the CT and MRI findings of congenital bilateral plexiform neurofibromas of the cavernous sinuses in a 2-month-old girl. Contrast-enhanced CT showed enhancement of masses in both cavernous sinuses and enlargement of both superior orbital fissures. On MRI the masses were isointense with muscle on T1-weighted images, hypointense on T2-weighted images and showed strong homogeneous enhancement on contrast-enhanced T1-weighted images. A dural tail sign was observed. The diagnosis was proven by biopsy.     

Nasal and lower airway levels of nitric oxide in prematurely born infants

BACKGROUND: Nitric oxide (NO) is produced by various cells in the respiratory tract, but the majority is released from the paranasal sinuses in adults. The paranasal sinuses in infants are only partially pneumatised. Thus, nasal NO would be predicted to be low in infants measured soon after birth and/or born very prematurely; this has implications for the measurement of exhaled NO and interpretation of the results obtained. OBJECTIVES: To determine whether nasal NO could be detected in very immature infants, particularly soon after birth, and whether nasal or lower airway NO levels were influenced by gestational age or postnatal age. PATIENTS: Fifteen infants, with median gestational age of 27 weeks (range 25-32 weeks). METHODS: Nasal and lower airway NO measurements were attempted on days 1, 3, 5, 7, 14, 21, and 28 after birth. Measurements were only made while the infants remained ventilated. Nasal NO was sampled directly from the nasal space and lower airway. NO was sampled from a catheter positioned so that its tip lay at the lower end of the endotracheal tube. RESULTS: Nasal NO was detected in all infants on all study occasions and the levels were greater than those from the lower airway. Nasal and lower airway NO levels did not correlate significantly with gestational age, but lower airway NO levels correlated with postnatal age (r=0.86, p=0.014). CONCLUSION: Even in very immature infants examined in the first day after birth, care must be taken to avoid contamination with nasal NO, if lower airway levels are to be accurately assessed.     

Color Doppler US of normal cerebral venous sinuses in neonates: a comparison with MR venography

Background

Color Doppler US (CDUS) has been used for evaluation of cerebral venous sinuses in neonates. However, there is very limited information available regarding the appearance of superficial and deep normal cerebral venous sinuses using CDUS and the specificity of the technique to rule out disease.

Objective

To determine the specificity, inter-modality and inter-reader agreement of color Doppler US (CDUS). To evaluate normal cerebral venous sinuses in neonates in comparison to MR venography (MRV).

Materials and methods

Newborns undergoing a clinically indicated brain MRI were prospectively evaluated. All underwent a dedicated CDUS of the cerebral venous sinuses within 10?h (mean, 3.5?h, range, and 2–7.6?h) of the MRI study using a standard protocol.

Results

Fifty consecutive neonates participated in the study (30 males [60%]; 25–41?weeks old; mean, 37?weeks). The mean time interval between the date of birth and the CDUS study was 19.1?days. No cases showed evidence of thrombosis. Overall agreement for US reading was 97% (range, 82–100%), for MRV reading, 99% (range, 96–100%) and for intermodality, 100% (range, 96–100%). Excellent US-MRI agreement was noted for superior sagittal sinus, cerebral veins, straight sinus, torcular Herophili, sigmoid sinus, superior jugular veins (94–98%) and transverse sinuses (82–86%). In 10 cases (20%), MRV showed flow gaps whereas normal flow was demonstrated with US. Visualization of the inferior sagittal sinus was limited with both imaging techniques.

Conclusion

Excellent reading agreement was noted for US, MRV and intermodality. CDUS is highly specific to rule out cerebral venous thrombosis in neonates and holds potential for clinical application as part of clinical-laboratory-imaging algorithms of pre/post-test probabilities of disease.