The "sinusogram", a real-time ultrasound sign of maxillary sinusitis

Objective: To describe a real-time ultrasound sign, the visualization of the cavity and the walls of the maxillary sinus ("sinusogram"), and to assess its correlation with total opacity of the sinus. Design: Prospective clinical study. Setting: The medical ICU of a university-affiliated hospital. Patients: The significance of this sign was assessed in 50 critically ill supine patients (100 maxillary sinuses) who underwent paranasal CT. Measurements and results: The "sinusogram" was defined as complete when the internal posterior walls were frankly visible, and incomplete in the case of partial visualization of the walls. The "sinusogram" was present in all 21 cases of total opacity, in 2 of 12 cases of air-fluid level, in 8 of 14 cases of mucosal thickening, in one giant polyp, and in none of 52 normal sinuses. The "sinusogram" was complete in 10 of 21 cases of total opacity. It was incomplete in 11 of 21 cases of total opacity and in all 8 cases of mucosal thickening with positive ultrasound. For the diagnosis of radiologic maxillary sinusitis (total opacity or air-fluid level within the maxillary cavity), the sensitivity was 67 % and the specificity 87 %. For the diagnosis of total opacity (versus absence of total opacity, which includes fluid level), the sensitivity was 100 % and the specificity 86 %. When the "sinusogram" was complete, the specificity was 100 % for the diagnosis of total opacity. Conclusions: Ultrasound may be proposed in first-line diagnosis of radiologic maxillary sinusitis.