Purpose or Case Report: The diagnostic approach to fever of unknown origin (FUO) in a neutropenic child is challenging. Recommendations of the Children's Oncology Group and the ACR provide some guidance, but evidence basis for use of sinus CT in the acutely febrile neutropenic child is poorly established. This presentation assesses baseline paranasal sinus mucosal thickening in children in 2 separate cities and compares them to children with neutropenia undergoing sinus CT in the work-up of FUO.
Methods & Materials: Data collected from 2 large children's hospitals in major metropolitan cities in the southern US. Hospital A is in a desert climate, Hospital B is in a humid subtropical climate. 18 consecutive sinus CTs were reviewed in neutropenic children undergoing diagnostic evaluation for FUO at Hospital A. Bone marrow transplant patients were excluded. All children were oncology patients undergoing treatment. Control groups used include 18 consecutive patients at hospital A and 18 consecutive patients at hospital B who presented to the ED requiring CT of the face. Control patients with a history of sinusitis, patients with a facial bone fracture, and patients with any oronasal support devices were excluded. No exams of neutropenic fever patients at hospital B were available, hospital B uses nasal endoscopy to assess for sinus disease in this population. Lund-Mackay (L-M) and modified Lund-Mackay scores were applied to all CT scans.
Results: The mean age in the neutropenic fever group was 9.86 years. The mean ages of hospital A and B control groups were 8.16 and 8.34 years, respectively. Age differences were not significantly different using a Student t-test. LM scores in the hospital A control group exhibited a mean of 5.50 with a mean modified-LM score of 6.92. Corresponding values in the hospital B control group were 3.11 and 4.00, respectively. In the neutropenic fever group of hospital A, the mean LM and modified-LM scores were 4.17 and 4.59, respectively. Findings viewed as "positive" in the neutropenic fever group resulted in 2 infectious disease and 2 ENT consults. All 4 consults concluded that fever was unlikely to be due to paranasal sinus disease, no intervention recommended.
Conclusions: Mucosal sinus thickening is omnipresent in children and can vary based on region. Baseline paranasal sinus mucosal thickening is greater among children living in a desert climate. The description of paranasal sinus mucosal thickening in neutropenic children may be of little value in the approach to fever without source.