Complications of acute bacterial rhinosinusitis

Complication	Clinical features	Imaging evaluation*
Preseptal cellulitis	Ocular pain, eyelid swelling, and erythema	Clinical diagnosis (imaging usually not needed unless there is concern for orbital cellulitis)
Orbital cellulitis	Ocular pain, eyelid swelling, and erythema plus pain with eye movements, proptosis, or visual changes suggesting involvement of the orbital tissue	CT with contrast or MRI without and with contrast of the head, including the orbit and paranasal sinuses
Subperiosteal abscess	Displacement of the globe, in addition to symptoms of orbital cellulitis	MRI without and with contrast of the head, orbit, and paranasal sinuses
Intracranial abscess	Headache with or without altered mental status, fever, or nausea/vomiting	CT with contrast or MRI without and with contrast of the head and paranasal sinuses
Meningitis	Fever, neck stiffness, and/or altered mental status	CT of the head without contrast may be indicated prior to lumbar puncture^¶
Septic cavernous sinus thrombosis	Cranial nerve palsies (CN III, IV, VI) with or without headache and fever	MRI without and with contrast of the head and paranasal sinuses. MR venography either without or with contrast.
Osteomyelitis	Dull pain at involved site often with overlying tenderness, erythema, or swelling	CT with contrast or MRI without and with contrast of the head and paranasal sinuses

CT: computed tomography; MRI: magnetic resonance imaging.
* Patient contraindications, severity of illness, available imaging modalities, and local expertise should also be taken into account when selecting an imaging approach.
¶ Refer to UpToDate content on clinical features and diagnosis of acute bacterial meningitis.

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Complications of acute bacterial rhinosinusitis