Abnormal images of the sinuses cannot stand alone as diagnostic evidence of bacterial rhinosinusitis. Radiologic changes such as mucosal thickening are present in most cases of acute viral infections of the upper respiratory tract when sensitive detection methods such as CT scanning are used. Incidental findings of mucosal thickening can also be seen in a high percentage of asymptomatic individuals.
For more information:
Desrosiers M, Evans GA, Keith PK, Wright ED, Kaplan A, Bouchard J, Ciavarella A, Doyle PW, Javer AR, Leith ES, Mukherji A, Robert Schellenberg R, Small P, Witterick IJ. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. Allergy Asthma Clin Immunol. 2011; 7(1): 2. PMID: 21310056.
Kirsch CF, Bykowski J, Aulino J, et al. Expert Panel on Neurologic Imaging: ACR Appropriateness Criteria® for Sinonasal Disease. J Am Coll Radiol. 2017 Nov;14(11S):S550-S559. PMID: 29101992.
Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152(2 Suppl):S1-S39. PMID: 25832968.
Young J, Bucher H, Tschudi P, Periat P, Hugenschmidt C, Welge-Lussen A. The clinical diagnosis of acute bacterial rhinosinusitis in general practice and its therapeutic consequences. J Clin Epidemiol. 2003;56:377–384. PMID: 12767415.