12-Year-Old With Facial Trauma

Differential Diagnosis

• Orbital fracture
• Sinus opacity
• Maxillary sinus fracture
• Nasal fracture

Diagnosis

The correct diagnosis is sinus opacity, as this x-ray demonstrates opacification of the right maxillary sinus with loss of the lateral sinus wall outline. Ultimately, it was discovered that this patient had a mass eroding the lateral sinus wall. Sinus opacity can be caused by many diseases including orbital floor/wall trauma, mucocele, neoplasm, and sinonasal polyposis.

What to Look For

• Clinically, look for pain, swelling, and tenderness over the affected sinus (maxillary, ethmoid, or sphenoid)
• On x-ray, loss of the air in the sinus or an air-fluid level within the sinus is present
• Maxillary sinus is the most prominent on x-ray; ethmoid and sphenoid sinuses are difficult to evaluate on plain radiography

Pearls for Urgent Care Management

• Unilateral maxillary sinus opacification is usually inflammatory in nature
• However, due to the varied causes, additional imaging (ie, CT sinus) is warranted for further evaluation

Acknowledgement: Images and case provided by Experity Teleradiology (www.experityhealth.com/teleradiology).

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