Sinus computed tomography findings in patients with COVID-19

Abstract

Objective: To analyze computed tomography scans of paranasal sinuses of a series of patients with coronavirus disease 2019, and correlate the findings with the disease.

Methods: Computed tomography scans of 95 adult patients who underwent a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were analyzed. Clinical data were obtained from patients' records and telephone calls. Paranasal sinus opacification was graded and compared according to severe acute respiratory syndrome coronavirus 2 positivity.

Results: Of the patients 28 (29.5%) tested positive for severe acute respiratory syndrome coronavirus 2 (median age 52 [range 26-95] years) and 67 were negative (median age 50 [range 18-95] years). Mucosal thickening was present in 97.4% of maxillary sinuses, 80% of anterior ethmoid air cells, 75.3% of posterior ethmoid air cells, 74.7% of frontal sinuses, and 66.3% of sphenoid sinuses. Minimal or mild mucosal thickening (score 1)and normally aerated sinuses (score 0) corresponded to 71.4% and 21.3% of all paranasal sinuses, respectively. The mean score of each paranasal sinus among severe acute respiratory syndrome coronavirus 2 positive and negative patients was 0.85±0.27 and 0.87±0.38, respectively (p=0.74). Median paranasal sinus opacification score among severe acute respiratory syndrome coronavirus 2 positive patients was 9 (interquartile range 8-10) compared to 9 (interquartile range 5-10) in negative patients (p=0.89). There was no difference in mean score adjusted for age and sex. Nasal congestion was more frequent in severe acute respiratory syndrome coronavirus 2 positive than negative patients (p=0.05).

Conclusion: Severe acute respiratory syndrome coronavirus 2 infection was associated with patient recall of nasal congestion, but showed no correlation with opacification of paranasal sinuses.

Figure 1. Coronal non-enhanced computed tomography scan of a severe acute respiratory syndrome coronavirus 2 positive patient shows normal aeration of the paranasal sinuses (score 0)

Figure 2. Coronal non-enhanced computed tomography scan of a severe acute respiratory syndrome coronavirus 2 negative patient shows mild mucosal thickening of the left maxillary sinus (score 1) and partial opacification (51% to 99%) of the right maxillary sinus (score 2)

Figura 1. Tomografia computadorizada coronal sem contraste de um paciente positivo para coronavírus 2 da síndrome respiratória aguda grave mostra aeração normal dos seios paranasais (pontuação 0)

Figura 2. Tomografia computadorizada coronal sem contraste de um paciente negativo para coronavírus 2 da síndrome respiratória aguda grave mostra discreto espessamento da mucosa do seio maxilar esquerdo (pontuação 1) e opacificação parcial (51% a 99%) do seio maxilar direito (pontuação 2)