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Sinusitis is commonly seen by both otolaryngologists and primary care physicians who treat pediatric patients. Judicious use of radiation is especially important in this population. When sinusitis is acute and uncomplicated, there is no indication for imaging. There are several clinical situations which may prompt consideration of imaging including persistent or chronic sinusitis and before a planned sinus surgery. In these situations, a non-contrasted CT is appropriate. Complicated sinusitis or concern for malignancy may prompt consideration of other imaging modalities. Caution must be used in interpreting the incidental finding of sinusitis on CT or MRI obtained for other clinical indications, as sinus changes are exceedingly common in asymptomatic patients. Here we discuss the indications for imaging and considerations for choice of imaging modality. We then highlight imaging findings in chronic and complicated sinusitis and discuss specific imaging changes found in cystic fibrosis and allergic fungal sinusitis. This chapter reviews the use of imaging in pediatric patients with sinusitis and the most common imaging findings.

In pediatric patients, viral upper respiratory infection is common. Approximately 10% of these patients will develop acute bacterial rhinosinusitis. The most common bacteria associated with acute rhinosinusitis are Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae. In chronic rhinosinusitis, defined as symptoms for greater than 3 months, bacteria interact with other factors including anatomic abnormalities, allergy, and immunodeficiencies. Polymicrobial infection is more common in chronic rhinosinusitis. Both acute and chronic sinusitis can have intracranial or extracranial complications. In these cases, there is an increasing role of staphylococci and anaerobes. An understanding of the microbiology of sinusitis guides proper antimicrobial selection. This chapter highlights the current concepts in the microbiology of acute, chronic, and complicated pediatric sinusitis.

HIV infection in the central nervous system (CNS) is responsible for a spectrum of neurocognitive and behavioral disorders. The wide use of appropriate combination antiretroviral therapy (cART) has decreased the severity of cognitive dysfunction. Viral loads are reduced and CD4+ T cell counts are increased. In addition, patients are living longer with improved quality of life. However, cART does not completely eliminate CNS dysfunction in HIV infected patients. There is an increase in milder forms of HIV-associated neurocognitive disorders (HAND), which are the result of a complex interplay between many factors including: aging, vascular disease, Alzheimer’s disease, and psychiatric disease. The underlying biochemical and molecular changes that underlie these changes and the underlying mechanisms of HAND pathogenesis continue to be an area of ongoing research. New advances in imaging and biomarker discovery will continue to advance clinical diagnosis and management. Treatments that can perturb the viral reservoirs and decrease chronic inflammatory response, in addition to continuing cART, may give the clinician additional tools to prevent HAND.