Reduced immunoglobulin M is associated with sinus mucosal thickening, osteitis and sinus surgery in patients with common variable immunodeficiency

Abstract

Background: Although common variable immunodeficiency (CVID) is associated with sinopulmonary disease, there are no previous systematic evaluations comparing computed tomographic (CT) sinus imaging with immunoglobulin measurements in patients with this condition.

Methods: We performed a retrospective review by a blinded observer using the Lund-Mackay numerical scoring scale as well as a visual scale for remodeling changes in the paranasal sinus bone on CT scans in CVID patients.

Results: The sinus CT scans of 19 subjects (9 males, 10 females; median age at diagnosis 34 years) are described. There was an inverse relationship between serum IgM and sinus mucosal thickening as described by the Lund-Mackay scale (R = -0.6398; p = 0.0032). Osteitis of the paranasal sinus bone was almost exclusively found in patients with a reduced serum IgM level of less than 25 mg/dl (p = 0.0074).

Conclusion: This is the first study to show that sinus mucosal thickening on CT in patients with CVID is inversely related to serum IgM levels.

Fig. 1

Noncontrast coronal sinus CT scans. a This is a normal study. The paranasal sinuses are clear. A small Haller air cell (normal variant) is present along the roof of the left maxillary sinus, without evidence of significant narrowing of the left maxillary infundibulum. b Postoperative changes of bilateral maxillary antrostomies with partial ethmoidectomies. Mild mucosal thickening involving the maxillary sinuses is present bilaterally and is greater on the left. There is mild hypoplasia and paradoxical rotation of both middle turbinates. The nasal septum is deviated to the right. c Bilateral, medial antrostomies are present. There is moderate membrane thickening which opacifies the inferior half of both maxillary sinuses. Membrane thickening and frothy-appearing material are present within an anterior left ethmoid air cell. There is mild chronic osteitis involving the lateral wall of both maxillary sinuses. d Membrane thickening results in complete opacification of the right maxillary sinus. There is a small amount of membrane thickening within the inferior left maxillary sinus. Postoperative changes of bilateral medial antrectomies, bilateral middle turbinectomies and partial inferior ethmoidectomies. e Moderate mucosal thickening with air fluid levels within the maxillary sinuses, slightly more marked on the left, consistent with acute sinusitis. Postoperative changes include bilateral maxillary antrostomies and adjacent partial ethmoidectomies. Mild scattered mucosal thickening is noted within residual ethmoid air cells. Chronic osteitis involves the roof and lateral wall of both maxillary sinuses. f Postoperative changes include a bilateral uncinectomy. Moderate mucosal thickening with frothy-appearing fluid is present in the left maxillary sinus. There is minimal mucosal thickening in the right maxillary sinus. The nasal septum is deviated toward the left. g Postoperative changes include a bilateral Caldwell-Luc procedure (arrows) and bilateral nasal antral windows, patent on the right but occluded by membrane thickening on the left. There is mild to moderate membrane thickening within the left nasal cavity and inferior ethmoid air cells. There is hypoplasia of the maxillary sinuses, greater on the left, and mild asymmetric enlargement of the left orbit compared to the right. Findings are consistent with sequelae of chronic maxillary atelectasis. h Scattered areas of thickening and sclerosis involve the walls of the maxillary and right sphenoid sinuses (small arrows), consistent with chronic osteitis.

Fig. 2

Association between IgM levels and sinus mucosal thickening.

Fig. 3

Association between IgM levels and osteitis on sinus CT.