Acute rhinosinusitis is major disease for otorhinolaryngologists. The medical treatment is often the use of antibiotics and most of patients are improvement. However, only slightly patients are not only improvement but also severe. Rhinogenic intracranial infection has been still one of the most serious complication, although advances in antibiotic therapy have reduced its incidence.
We experienced that a healthy 15-year-old boy with headache was diagnosed with right sphenoiditis by CT and with clival bone marrow edema by MRI. The antibiotic therapy made his condition better and CRP and white blood cells improving. But otherwise, rhinosinusitis was getting worse by CT. We performed endoscopic sinus surgery and continued antibiotic therapy for three weeks, so that disease progression resolved and he completely cured. MRI after four postoperative months showed the normal clival bone marrow without sinusitis.
“Bone marrow edema” is a term of a characteristic signal pattern on MRI. It describes an altered signal pattern (decreased T1 signal and increased T2 signal) of a specific part of bone marrow. Clival bone marrow edema with rhinosinusitis (especially sphenoiditis) is may be important sign like before clival osteomyelitis and intracranial infection. In general, MRI sagittal view provides a method for evaluating clivus. When a patient might have rhinogenic intracranial infection, MRI sagittal view of clivus may be useful for diagnosis and treatment.
