A two year old child with a long history of purulent nasal discharge & fever now presents with conjunctival congestion and edema. His fever is 102o/103oF and WBC count 12000. The culture of eye discharge was negative. X-ray show opacification of ethmoid sinus. Which of the following should be the next step in evaluating this patient -
The child is presenting with fever and purulent nasal discharge with X-ray PNS showing opacification of ethmoidal sinus, i.e. probably the child is having chronic sinusitis (as it is present for the past 2 months) with an acute exacerbation. Now the most dreaded complication of ethmoidal sinusitis is orbital complication.
“Orbital complication – most of the complications, follow infection of ethmoids as they are separated from the orbit only by a thin lamina of bone – lamina papyracea. Infection travels from these sinuses either by ostitis or a thrombophlebitic process of ethmoidal veins.”
The best method to assess the status of ethmoidal air cells and its complications is CT scan. “CT is particularly useful in ethmoid and sphenoid sinus infections and has replaced studies with contrast material.”
CT scan
Urine culture
Blood culture
Repeat culture of eye discharge