Which imaging modality is most appropriate to evaluate the sinuses when there is a history of trauma with epistaxis?

• A. CT
• B. Ultrasound
• C. MRI
• D. Plain Radiographs

Answer: (A)

When trauma and bleeding from the nose raise concern for facial bone injuries, the priority is to quickly and accurately reveal fractures of the nasal bones and surrounding sinuses, along with any orbital or base skull involvement. A non-contrast CT scan of the facial bones and paranasal sinuses provides highly detailed, multiplanar images that detect acute fractures, nasal septal injuries, sinus hematomas, and orbital rim fractures far more reliably than other tests. It’s fast, widely available, and specifically designed to evaluate bone anatomy in the acute setting. Ultrasound isn’t effective for air-filled sinuses or complex facial bones; plain radiographs miss many fractures due to overlapping structures; MRI excels at soft tissue but is slower and less sensitive for acute bony injuries.