Gutowski W M, Mulbury P E, Hengerer A S, Kido D K
Department of Otolaryngology, University of Rochester, NY 14642.
Int J Pediatr Otorhinolaryngol. 1988 May;15(2):117-28. doi: 10.1016/0165-5876(88)90062-6.
Thirty-three cases of ethmoidities with orbital complications were reviewed to determine the accuracy of clinical diagnosis and the benefit of CT scans in planning treatment. Patients were classified according to the Schramm et al. 1982 criteria of orbital involvement with ethmoiditis: periorbital cellulitis with chemosis (PCC)-9, and orbital cellulitis (OC)-11, subperiosteal abscess (SPA)-9, and orbital abscess (OA)-4. These patients received CT scans acutely for diagnostic purposes and demonstrated an 84% accuracy with the final clinical groupings. Of 33 patients, 9 had a shift in clinical classification based on the CT scan result interpreted by the Radiology Department or surgical findings. There were no false positives in the periorbital or orbital cellulitis patients, and no false negatives in the subperiosteal and orbital abscess patients. Thus classification changes caused no change from medical to surgical treatment in any of the cases. The conclusion is that a knowledgeable clinical exam established the correct grouping in 70% of the patients versus 82% with the CT scan. An urgent CT scan is advised for patients in clinical groups SPA, OA, or cavernous sinus thrombosis (CST) to determine the imminent need for surgery, as the cases may be underestimated. Patients with PC or PCC can be managed medically with elective CT scans not routinely indicated.
回顾了33例伴有眶部并发症的筛窦炎病例，以确定临床诊断的准确性以及CT扫描在制定治疗方案中的作用。根据施拉姆等人1982年提出的筛窦炎累及眼眶的标准对患者进行分类：伴有球结膜水肿的眶周蜂窝织炎（PCC）9例、眶蜂窝织炎（OC）11例、骨膜下脓肿（SPA）9例、眶脓肿（OA）4例。这些患者为诊断目的进行了急诊CT扫描，最终临床分组显示其准确率为84%。在33例患者中，9例患者的临床分类根据放射科解读的CT扫描结果或手术发现发生了改变。眶周或眶蜂窝织炎患者中无假阳性，骨膜下和眶脓肿患者中无假阴性。因此，在任何病例中，分类变化均未导致从内科治疗改为外科治疗。结论是，经验丰富的临床检查在70%的患者中确定了正确的分组，而CT扫描的准确率为82%。建议对临床分组为SPA、OA或海绵窦血栓形成（CST）的患者进行急诊CT扫描，以确定是否急需手术，因为这些病例可能被低估。PC或PCC患者可采用内科治疗，选择性CT扫描并非常规必需。
