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CT Screening Can Predict Life Threatening Sinusitis to Children Undergoing Bone Marrow Transplants

Sinusitis, annoying and painful to adults, can be deadly to a child requiring a bone marrow transplant. Three Texas medical specialists believe CT screening prior to the transplant offers a blueprint to ensure that sinus disorders will not lead to a dangerous infection.

Children and Bone Marrow Transplantation
A traumatic event occurs for any family when a child has to undergo bone marrow transplantation (BMT) for treating malignant disorders, such as myelogenous leukemia, or nonmalignant illnesses, such as aplastic anemia or Fanconi's anemia. Many parents are not aware that before the BMT, a child's white blood cell count is severely reduced, resulting in high risk for infectious complications, most commonly sinusitis. This infection, often an annoyance to a healthy adult, can be deadly to the BMT recipient. Adding to a physician's concern is that the young patient may not present symptoms that would indicate the onset of sinusitis.

Two otolaryngologist-head and neck surgeons and a pediatric radiologist have completed a retrospective research study which sought to determine if sinus disease noted on CT (computed tomography) screening had any relationship to clinical course and prognosis of young children undergoing bone marrow transplant. The study results were presented before a meeting of the American Society of Pediatric Otolaryngology.

The authors of the research study are Kathleen R. Billings, MD, Lisa H. Lowe, MD, and Michael J. Biavanti, MD, from the University of Texas Southwestern Medical Center, Dallas, TX.

Methodology:
The three medical specialists conducted a retrospective review of the medical records, CT scans, and BMT data for all pediatric bone marrow transplant recipients at the

Children's Medical Center of Dallas from January, 1992, to January, 1998. In this time period, 54 screening sinus CT scans were performed on 51 children with an average age of 6.8 years. The most common oncologic diagnoses encountered were malignant disorders: acute myelogenous leukemia (37% of patients), followed by acute lymphoblastic leukemia (17%), and stage IV neuroblastoma (14%). Sinus disease on pre-BMT scans was staged according to established criteria, and the findings were then correlated to subsequent clinical course and prognosis.

Results:
Overall, 39.3% of patients with sinus abnormalities on pre-BMT CT scans had sinus complaints at some point following the bone marrow transplant. This compares to 23.1% of the patients who had normal CT screening scans but later developed sinus problems.

Severity of radiographic sinus disease on pre-BMT CT scans was noted to correlate with clinically significant sinusitis later in the post-BMT, and associated with decreased survival in the young patients. Pre-BMT CT scans may be useful in determining which children need early and more aggressive intervention for clinical sinusitis after their bone marrow transplant.
Source: American Academy of Otolaryngology Head and Neck Surgery (AAOHNS)

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