title: A postural change test improves the prediction of a radiological maxillary sinusitis by ultrasonography in mechanically ventilated patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate a postural change test during sinus ultrasound, compared with CT scan, in case of partial sinusogram to differentiate air-fluid level from mucosal thickening.
  
  
  METHODS
  Prospective clinical investigation.
  
  
  METHODS
  Medical intensive care unit.
  
  
  METHODS
  150 intubated patients.
  
  
  METHODS
  Patients were examined by sinus ultrasound in half-sitting position. A partial sinusogram was defined as the sole visualization of the hyperechogenic posterior wall of the sinus. In this situation, a postural change was performed and ultrasound was achieved in supine position. If the partial sinusogram disappeared when the patient was placed in a supine position (positive test), the partial sinusogram was an air-fluid level. If the partial sinusogram did not disappear (negative test), we considered it as a mucosal thickening. The CT and ultrasound were performed on the same day. Radiological maxillary sinusitis (RMS) on CT was defined as the presence of an air-fluid level. Absence of RMS on CT was defined as normal sinus or as the presence of mucosal thickening.
  
  
  RESULTS
  300 sinuses were examined. A partial sinusogram was found in 90 sinuses and CT scan confirmed the presence of RMS in 55 sinuses (61%). Sensitivity, specificity, positive predictive value, and negative predictive value of postural change test compared with CT were, respectively, 94.6, 85.6, 91.2 and 90.9%. The positive predictive value increased from 61 to 91.2% after the postural change test.
  
  
  CONCLUSIONS
  In case of a partial sinusogram, a postural change increases the accuracy of ultrasound to diagnose RMS.
authors.affiliation: Hôpital Pellegrin Tripode, Département de réanimation médicale, 33076 Bordeaux Cedex, France. frederic.vargas@chu-bordeaux.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Vargas
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boyer
authors.forename: Hoang Nam
authors.initials: HN
authors.lastname: Bui
authors.forename: Louis Rachid
authors.initials: LR
authors.lastname: Salmi
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
authors.forename: Gilles
authors.initials: G
authors.lastname: Hilbert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000175:diagnosis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D015523:Maxillary Sinusitis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D012121:Respiration, Artificial; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography