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.