Cat Scan Sinuses?

[Joan Pandas Mom]

I hope everyone is hanging in there. I haven't been writing, busy taking care of sick son. We are 4 weeks tomorrow IVIG. It was our second one. We are seeing 5-10% improvement, but backsliding over the past couple of days. DS was having bloody noses about 4-5 weeks ago, daily for about 3 weeks. Dr. B. told me to take him to Dr. here. We saw the ENT today. DS has either a strep or staph infection in his nostrils. ENT gave him Bactroban ointment and wants to wait to see how he does over the next few weeks before giving him a cat scan. DS is on 500 mg Azithro daily, has been for 3 1/2 weeks now. Has anyone had a sinus infect. detected only with CT? I hate to expose him to the radiation, but could this be the piece we are missing? What is the typical abx for staph or strep in sinuses? Thanks for any suggestions.

[philamom]

My daughter's CT scan diagnosed a sinus infection (PAN Sinusitus= all cavities blocked). Although, I don't think it can reveal if it's from strep or staph. We used Augmentin to clear sinus infections.

[smartyjones]

we did have CT for sinus -- when still beginning pandas journey. he had sudden onset, high titers and positive culture. useless ped perfunctorily threw him on 5-days azith just as CYA, with statement, "you'll find the behaviors and the strep are not related."

 

he didn't seem to be having abnormal sinus trouble for a 4 1/2 year old in the winter -- just pandas behaviors. although, he did complain of an eye ache 6 months prior when i had a sinus infection.

 

got a new ped, ordered sinus CT which showed all 6 cavities blocked. we used keflex b/c he had a terrible reaction to azith (could it have been lyme herx- ?; later got lyme diagnosis). all behaviors resolved w/i about 3 days of keflex. 2nd CT showed much improvement. he relapsed with behaviors after about 30 days off keflex.

 

dr offered we could do 3rd CT to check but was confident we'd hit it hard and 2nd showed improvement -- so we didn't do a 3rd CT b/c of radiation and just assumed sinuses had cleared. could there still had been strep bacteria there? i think you'd have to keep doing CTs and i think drs think the abx will handle it and so don't expose to the radiation. it's so hard to determine if you've actually gotten the bacteria.

 

i think there's been some mention of culturing sinuses on this forum but i think it's not done so often -- did your ENT discuss that as an option?

 

a dr early on told me when first in practice, she ran all kinds of tests -- now she only tests what will change/guide her treatment decisions. did you discuss with ENT what differences the CT result will make in treatment?

[EAMom]

I believe Diana P.'s son had an MRI at one point that found a sinus infection (as an incidental finding...they were looking at brain/basil ganglia).

 

Does anyone know why they can't use MRI for this more often? (MRI's don't have the radiation issue.)

[PhillyPA]

My son had an MRI during his first pandas episode. He had a complete sinus blockage.

[Joan Pandas Mom]

He had a nasal swab about 7 months ago that was negative. I'm not sure if it cultured the sinuses though. The ENT today could see his nasal passage way was infected (had a little crusty stuff in there).That's a good about if the CT showed anything. I wonder what they would do differently if something showed on the CT. DS has been on different high dose abx for 1 year now, we have tried Augmentin, Biaxin, Azithro, Clindymicin,

[T_Mom]

During the worst exacerbation our d had an MRI. It showed sinus congestion--we subsequently treated her with a steroid burst and Amoxicillan full strength...She cleared.

[kimballot]

Joan - CT scans are scary, and I do not like the idea of radiation, but a sinus CT really saved my son. If you are thinking it is sinus and he is not responding to typical ABX., consider the scan. Here is my story http://www.latitudes.org/forums/index.php?showtopic=8291&hl

[kimballot]

I believe Diana P.'s son had an MRI at one point that found a sinus infection (as an incidental finding...they were looking at brain/basil ganglia).

 

Does anyone know why they can't use MRI for this more often? (MRI's don't have the radiation issue.)

 

They don't use MRIs much because MRIs have good resolution of body tissue - not body spaces, so they really do not image the sinuses well to show the infections. Sinus CT scans are much more clear (at least that is what the ENT and immunologist have both told me).... I would certainly prefer an MRI, but I've not been able to convince anyone to go that route.

[Joan Pandas Mom]

Kim, Thank you for this. I don't know how I missed this I'm just reading it now. PANDAS is making me lose my mind! I'm wondering if the Bactroban the ENT prescribed will clear what can be seen by eye. Something tells me to have the CT regardless.

[kimballot]

Joan - That is a tough call. I guess it depends on how long this has been going on. You could try the bactroban and see if there is a reduction in PANDAS symptoms. I know that for my son we saw a resolve of sinus symptoms with antibiotics, but we did not see much reduction of PANDAS symptoms. That is what led Dr. B to want to look further in the sinuses. If I knew then what I know now - I would have also been checking lyme at that time. I knew there was an infection lurking somewhere... we just needed to find it.... and there it was right next to his eye! Ethmoid and frontal sinus infections are hard to find without a CT scan.

 

Let us know what you end up doing - I hope you find some resolve!

[kimballot]

My son had an MRI during his first pandas episode. He had a complete sinus blockage.

 

Philly - that is great. (I mean it is great that you had an MRI for diagnostics - not great that your son was completely blocked!!)Did an ENT order the MRI? I've not been able to get docs to do MRI to check sinuses.

Edited November 9, 2010 by kimballot