What is the diagnostic test of choice for acute sinusitis?

• A. Sinus radiographs (Water's view)
• B. MRI with gadolinium
• C. CT scan without contrast
• D. Ultrasound

Answer: (C)

Imaging for acute sinusitis is not routinely needed, but if it’s required, a CT scan of the paranasal sinuses without contrast is the best choice. It provides rapid, detailed images of the sinus air spaces, showing mucosal thickening, sinus opacification, and any obstruction of the ostiomeatal complex, as well as bone details. This helps confirm sinusitis and assess for potential complications.

Plain sinus X-rays (Water’s view) are insensitive and often miss disease. MRI with gadolinium is unnecessary for straightforward acute sinusitis and is reserved for suspected intracranial or orbital complications. Ultrasound isn’t effective for evaluating the paranasal sinuses due to poor visualization of the bony sinus compartments.