Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35,20122, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Ital J Pediatr. 2020 Jul 14;46(1):97. doi: 10.1186/s13052-020-00863-y.
Complications of acute sinusitis affecting multiple sites are very uncommon, and generally develop for a delayed diagnosis of the primary infection, with possible severe and life-threatening evolution. Patients can have variable presentations according to the site and extent of the infection. Multiple forms generally include the coexistence of orbital manifestations and intracranial infections. We here present a case with unusual multiple sites locations (i.e.: intraorbital intraconic abscess, sigmoid sinus thrombosis, preclival abscess, multiple splanchnocranium osteomyelitic processes).
A 13-year-old male presented at our hospital with right progressive orbital oedema with eyesight worsening and signs of meningitis. Computed tomography and magnetic resonance (MRI) demonstrated right intraorbital intraconic abscess, left sphenoidal sinusitis, transverse and sigmoid sinus thrombosis. Ophthalmologic evaluation documented a right optic nerve sufferance. Endoscopic and superior right trans-palpebral surgical decompression was performed, and the abscess was drained. Microbiological analysis revealed the presence of multi-sensitive Streptococcus Intermedius. Subsequent prolonged antibiotic and anti-thrombotic treatments were started. In the following two-weeks the sinusal and ophthalmologic clinical conditions improved, whereas the patients complained of mild to moderate cervical pain and suffered from intermittent pyrexia. Control MRI documented clival abscess extending up to preclival soft tissues posterior to the nasopharynx, associated with mandible osteomyelitis, occipital condyles and anterior part of the temporal bone hyper intensity. Endoscopic trans-nasal surgical approach to the clival compartment with neurosurgery navigation-guided achieved preclival abscess drainage. Complete clinical and radiological recovery was achieved after 45 days of medical treatment.
Multiple sites complicated rhinosinusitis is uncommon, and its management is challenging. A proper history and thorough clinical examination along with a radiological evaluation are key factors in the final diagnosis of patients with complicated multiple sites acute rhinosinusitis. A quick multidisciplinary approach is always necessary to avoid unwanted life-threatening complications.
影响多个部位的急性鼻窦炎并发症非常罕见，通常是由于原发性感染的诊断延迟导致的，可能会出现严重且危及生命的进展。患者的表现根据感染部位和范围的不同而有所不同。多种形式通常包括眼眶表现和颅内感染的共存。我们在此介绍一例不常见的多部位病变（即：眶内骨锥内脓肿、乙状窦血栓形成、斜坡前脓肿、多个颅底骨骨髓炎病变）。
一名 13 岁男性因右眼进行性眶周水肿、视力下降和脑膜炎迹象就诊于我院。计算机断层扫描和磁共振成像（MRI）显示右侧眶内骨锥内脓肿、左侧蝶窦炎、横窦和乙状窦血栓形成。眼科评估发现右侧视神经受累。进行了经鼻内镜和右上眼睑切开减压手术，并引流脓肿。微生物分析显示存在多敏性中间链球菌。随后开始了长期的抗生素和抗血栓治疗。在接下来的两周内，鼻窦和眼科临床状况得到改善，但患者抱怨轻度至中度颈痛，并间歇性发热。控制 MRI 显示斜坡前脓肿延伸至鼻咽后部的斜坡前软组织，伴有下颌骨骨髓炎、枕骨髁和颞骨前部高信号。采用经鼻内镜神经外科导航引导的方法对斜坡间隙进行了手术引流。经过 45 天的药物治疗，患者完全康复。
多部位复杂的鼻旁窦炎并不常见，其治疗具有挑战性。适当的病史和详细的临床检查以及影像学评估是最终诊断复杂多部位急性鼻旁窦炎患者的关键因素。快速的多学科方法始终是必要的，以避免不必要的危及生命的并发症。
