Bone scintigraphic diagnosis in acute frontal sinusitis

The diagnostic value of Technetium 99m Methylene Diphosphate bone scintigraphy was evaluated in 21 patients, 10 of them with acute frontal sinusitis and a "fluid level" on sinus radiography. Pathologic accumulation of the radioisotope over the region corresponding to the diseased frontal sinus was observed in 9 of these 10 patients, 5 of them having a marked accumulation. The patients with marked accumulation of the bone-seeking radioisotope had a more severe clinical course of the disease than those who had a moderate or no accumulation of the radioisotope. Marked accumulation of the radioisotope was also found in a patient with "inflammatory pseudotumor of the orbit". The radioisotope did not accumulate over the frontal sinus of patients with mucosal swelling or cellulitis of face, or in control patients with mastoid disease. Based on our findings, we recommend bone scintigraphy be performed routinely for diagnosis of acute frontal sinusitis. A marked accumulation of Tc99m MDP indicates inflammatory metabolic changes of the sinus bony walls, predicting a severe clinical course and the necessity of aggressive treatment.