A 10-year-old girl has a 2-week history of daily headaches and rhinorrhea. She is admitted from the emergency department to the pediatric intensive care unit for a 2-day history of worsening left frontal headache, mental status changes including lethargy and slurred speech, nausea, and mild periorbital edema. Computed tomography (CT) demonstrates opacification of bilateral frontal, maxillary, and anterior ethmoid sinuses as well as pneumocephalus (Figure 27-1A). Magnetic resonance imaging demonstrated extensive left sided subdural empyema (worse frontal and temporal) and diffuse bilateral dural enhancement (Figure 27-1B). She is urgently treated via a combined surgical approach with pediatric otolaryngology for bilateral endoscopic sinus surgery and pediatric neurosurgery for left craniotomy. She subsequently had 10 weeks of intravenous antimicrobial therapy. Her immediate postoperative course was complicated by seizures; she has now made a full recovery and is doing well.
Complications of acute sinusitis are typically extensions of infection beyond the paranasal sinuses into adjacent structures and can have devastating consequences, including blindness, neurologic morbidity, and even death.
Periorbital cellulitis, subperiosteal abscess, orbital cellulitis, orbital abscess, cavernous sinus thrombosis, meningitis, subdural abscess, subdural empyema, pyocele, mucopyocele, intracranial abscess, or invasive fungal sinusitis.