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Dorchester Center, MA 02124
‘Lil stuffy noses: Sinusitis
Case presentation
A 15-year-old male presents to the Emergency Department with a complaint of “severe headaches” for the past week. He states he has had cough, which is worse at night, and congestion for the past 2 weeks. He has had minimal rhinorrhea that was initially clear, then green, and is now clear again. He initially had a temperature of 101 degrees Fahrenheit, but this resolved after 2 days. He denies vomiting, sore throat, ear pain, vision changes, weakness, difficulty ambulating, or neck pain. There is no report of trauma. He states that the headache has been waking him up from sleep and has been present in the morning for the past 3 days. There is minimal relief with over-the-counter ibuprofen. His physical examination reveals a well-appearing patient who is afebrile and has unremarkable vital signs. He is normocephalic and atraumatic. There is no photophobia and his extraocular muscles are intact without proptosis or conjunctival erythema. There is no cobblestoning. He has mild nasal congestion with rhinorrhea; the nasal turbinates are mildly edematous. There is no facial edema, tenderness, signs of trauma, or erythema. His neurologic examination is nonfocal.
Imaging considerations
Routine imaging for suspected routine sinusitis is not recommended, as this is a clinical diagnosis that follows strict criteria. The majority of children with uncomplicated upper respiratory tract infection who undergo imaging of the paranasal sinuses, whether plain radiography, noncontrast computed tomography (CT), or magnetic resonance imaging (MRI), will have abnormal findings, including air-fluid levels and mucosal thickening. , While the findings of clear paranasal sinuses may exclude sinusitis, abnormal findings do not secure a diagnosis of sinusitis. Imaging should be reserved for patients with potential sinusitis who have a suspected complication from sinusitis or if surgical intervention is planned.
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