Radiologic Assessment of the Sinonasal Tract, Nasopharynx and Mastoid Cavity in Patients with SARS-Cov-2 Infection Presenting with Acute Neurological Symptoms.

Gul Moonis,Ryan Mitchell,Anil K Lalwani,Betsy Szeto

doi:10.1177/0003489421995070

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https://doi.org/10.1177/0003489421995070

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Abstract

Background:Acute neurological sequela in patients with COVID-19 infection include acute thromboembolic infarcts related to cytokine storm and post infectious immune activation resulting in a prothrombotic state. Radiologic imaging studies of the sinonasal tract and mastoid cavity in patients with COVID-19 infection are sparse and limited to case series. In this report, we investigate the radiologic involvement of nasal cavity, nasopharynx, paranasal sinuses, and mastoid cavity in patients with SARS-CoV-2 infection who presented with acute neurological symptoms.Methods:Retrospective review of medical records and neuroradiologic imaging in patients diagnosed with acute COVID-19 infection who presented with acute neurological symptoms to assess radiologic prevalence of sinus and mastoid disease and its correlation to upper respiratory tract symptoms.Results:Of the 55 patients, 23 (42%) had partial sinus opacification, with no evidence for complete sinus opacification. The ethmoid sinus was the most commonly affected (16/55 or 29%). An air fluid level was noted in 6/55 (11%) patients, most commonly in the maxillary sinus. Olfactory recess and mastoid opacification were uncommon. There was no evidence of bony destruction in any of the studies, Cough, nasal congestion, rhinorrhea, and sore throat were not significantly associated with any radiological findings.Conclusion:In patients who present with acute neurological symptoms, COVID-19 infection is characterized by limited and mild mucosal disease within the sinuses, nasopharynx and mastoid cavity.Level of Evidence:4

Highlights

Human coronavirus (HCoV), a family of single positive stranded RNA viruses, including 229E, OC43, NL63, HKU1, SARS, MERS (Middle East respiratory syndrome) and SARS-CoV-2 (COVID-19, coronavirus disease 2019) are a frequent cause of the common cold, respiratory infection, and middle ear pressure abnormalities.[1,2,3] In one study of children with HCoV, the most common findings were cough, rhinorrhea, tachypnea, fever, abnormal breath sounds, and hypoxia.[4]
URI symptoms are common among patients with COVID-19 infection, including cough, sore throat, congestion or runny nose.[5]
Increased viral load in the nasopharynx and oropharynx is the basis for detection of SARS-CoV-2 by real-time reverse-transcriptase polymerase-chain-reaction (RT-PCR) assays collected by nasal and oropharyngeal swabs.[9]

Summary

Introduction

Human coronavirus (HCoV), a family of single positive stranded RNA viruses, including 229E, OC43, NL63, HKU1, SARS, MERS (Middle East respiratory syndrome) and SARS-CoV-2 (COVID-19, coronavirus disease 2019) are a frequent cause of the common cold, respiratory infection, and middle ear pressure abnormalities.[1,2,3] In one study of children with HCoV, the most common findings were cough, rhinorrhea, tachypnea, fever, abnormal breath sounds, and hypoxia.[4]. Radiologic imaging studies of the sinonasal tract and mastoid cavity in patients with COVID-19 infection are sparse and limited to case series. We investigate the radiologic involvement of nasal cavity, nasopharynx, paranasal sinuses, and mastoid cavity in patients with SARS-CoV-2 infection who presented with acute neurological symptoms. Methods: Retrospective review of medical records and neuroradiologic imaging in patients diagnosed with acute COVID-19 infection who presented with acute neurological symptoms to assess radiologic prevalence of sinus and mastoid disease and its correlation to upper respiratory tract symptoms. Conclusion: In patients who present with acute neurological symptoms, COVID-19 infection is characterized by limited and mild mucosal disease within the sinuses, nasopharynx and mastoid cavity.

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