Utility of diagnostic sinus CT for diagnosis of invasive fungal sinusitis in immunocompromised children

Purpose/objective

To investigate the utility of Sinus CT imaging in the diagnosis or suspicion of invasive fungal sinusitis in immunocompromised children.

Study design

Retrospective chart review.

Setting

Tertiary-care pediatric hospital.

Subjects and results

Between 2012 and 2020, the Otolaryngology service at Children's Wisconsin was consulted 102 separate times in 83 patients for concern for persistent fevers of unknown origin in immunocompromised patients with concern for invasive fungal infection (IFS). There was a CT scan associated with consultation in 82 (80 %) and 49 % had been obtained prior to Otolaryngology consultation. IFS was confirmed on biopsy on 8 (10 %) of patients and 6 (7 %) had concerning findings on bedside nasal endoscopy. The remaining two patients had congestion but lacked other findings on bedside nasal endoscopy. However, they were taken to the OR for facial swelling (1/8) for high clinical suspicion prompting a CT which demonstrated a septal abscess.

Conclusions

CT imaging is a highly used modality for the evaluation of invasive fungal sinusitis. Our data demonstrates no significant difference between the CTs ordered on patients with invasive fungal disease and those without. Bedside nasal endoscopy remained the primary driver for operative biopsy, though, one case was prompted by CT imaging. We advocate for bedside nasal endoscopy as the primary screening in these patients. However, for those with a negative bedside nasal exam but a high index of suspicion, CT imaging may play a role in further evaluation.