Lund-Mackay

CT staging of chronic rhinosinusitis

Scores paranasal sinus opacification on CT to stage chronic rhinosinusitis, summing paired sinus groups and the ostiomeatal complex to a maximum of 24.

vigenteRhinology consensus / AAO-HNS Task Force1993CT

Fonte primária 5 categorias

0Per-sinus score 0, no abnormality or opacification 1Per-sinus score 1, partial opacification 2Per-sinus score 2, total opacification OMCOstiomeatal complex, 0 if not obstructed or 2 if obstructed TOTALExact bilateral Lund-Mackay total, 0-24

Aplicar o Lund-Mackay a um achado

Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.

Categorias

Reescritas a partir da fonte e citadas

1 de 5

Per-sinus score 0, no abnormality or opacification

For one maxillary, anterior ethmoid, posterior ethmoid, sphenoid or frontal sinus on one side, assign 0 when CT shows no abnormality or opacification. An aplastic frontal sinus also contributes 0 and is recorded separately as an anatomic variant.

CondutaUse this value only as one component of right/left anatomic staging and the 0-24 total. The system defines no treatment action for a component score of 0; correlate the CT with symptoms, endoscopy and the clinical diagnosis.

RiscoThis is an opacification component, not an independent outcome-risk stratum; the system assigns no per-component complication probability.

verificadoStaging in rhinosinusitisLund and Mackay 1993, p.183, radiological staging paragraph: each sinus group 0=no abnormality, 1=partial opacification, 2=total opacification; p.183-184 and Table 1 list absent frontal sinus as a separately recorded variant. Lund and Kennedy 1997, radiologic grading discussion, addresses the absent-frontal-sinus case.

2 de 5

Per-sinus score 1, partial opacification

For one maxillary, anterior ethmoid, posterior ethmoid, sphenoid or frontal sinus on one side, assign 1 when CT shows partial opacification. All degrees of partial opacification remain in this single category.

CondutaUse this value only as one component of right/left anatomic staging and the 0-24 total. The system defines no treatment action for partial opacification alone; correlate the CT with symptoms, endoscopy and the clinical diagnosis.

RiscoThis is an opacification component, not an independent outcome-risk stratum; the system assigns no per-component complication probability.

verificadoStaging in rhinosinusitisLund and Mackay 1993, p.183, radiological staging and simplification paragraphs: score 1 means partial opacification and intentionally combines every degree of partial opacification in one category.

3 de 5

Per-sinus score 2, total opacification

For one maxillary, anterior ethmoid, posterior ethmoid, sphenoid or frontal sinus on one side, assign 2 when CT shows total opacification of that sinus group.

CondutaUse this value only as one component of right/left anatomic staging and the 0-24 total. The system defines no treatment action for total opacification alone; correlate the CT with symptoms, endoscopy and the clinical diagnosis.

RiscoThis is an opacification component, not an independent outcome-risk stratum; the system assigns no per-component complication probability.

verificadoStaging in rhinosinusitisLund and Mackay 1993, p.183, radiological staging paragraph and p.184 Table 1: score 2 means total opacification for each sinus group.

OMC

4 de 5

Ostiomeatal complex, 0 if not obstructed or 2 if obstructed

Score the ostiomeatal complex separately on each side: 0 when it is not obstructed and 2 when it is obstructed. There is no 1-point OMC state.

CondutaAdd the OMC value to the five ipsilateral sinus-group values. The system defines no OMC-specific treatment action; describe the obstruction and integrate it with the remaining CT, endoscopic and clinical findings.

RiscoOMC 0 or 2 is a staging component rather than a standalone risk category, and the original system provides no OMC-specific event probability.

verificadoStaging in rhinosinusitisLund and Mackay 1993, p.183, radiological staging paragraph and p.184 Table 1: OMC is 0 if unobstructed or 2 if obstructed.

TOTAL

5 de 5

Exact bilateral Lund-Mackay total, 0-24

Sum the maxillary, anterior ethmoid, posterior ethmoid, sphenoid, frontal and OMC values on each side for a subtotal of 0-12; add right and left subtotals for the exact bilateral Lund-Mackay total of 0-24.

CondutaReport the exact right subtotal, left subtotal, bilateral total and component scores. The original system supplies no mild/moderate/severe cutoffs and no numeric threshold that by itself selects medical or surgical treatment.

RiscoA larger total denotes greater CT opacification burden, but the 0-24 scale is not divided into calibrated individual risk strata and does not supply a per-score prognosis.

verificadoStaging in rhinosinusitisLund and Mackay 1993, p.183: total range 0-24 and 0-12 per side; p.184 Table 1 lists the five sinus groups plus OMC. The original article provides no categorical total-score bands.

Lógica de decisão estruturada

Return every right/left component, both side subtotals and the exact 0-24 total. Keep anatomic variants separate and do not invent severity cutoffs.

{
  "applicability": {
    "use_for": "CT staging of the anatomic extent of non-neoplastic chronic rhinosinusitis.",
    "score_each_side_separately": true,
    "sides": [
      "right",
      "left"
    ]
  },
  "feature_groups": [
    {
      "id": "paired_sinus_groups",
      "structures_per_side": [
        "maxillary",
        "anterior_ethmoid",
        "posterior_ethmoid",
        "sphenoid",
        "frontal"
      ],
      "options": [
        {
          "outcome_code": "0",
          "finding": "no_abnormality_or_opacification",
          "points": 0
        },
        {
          "outcome_code": "1",
          "finding": "partial_opacification",
          "points": 1
        },
        {
          "outcome_code": "2",
          "finding": "total_opacification",
          "points": 2
        }
      ]
    },
    {
      "id": "ostiomeatal_complex",
      "outcome_code": "OMC",
      "options": [
        {
          "finding": "not_obstructed",
          "points": 0
        },
        {
          "finding": "obstructed",
          "points": 2
        }
      ]
    }
  ],
  "special_cases": {
    "aplastic_frontal_sinus": {
      "score": 0,
      "record_as_anatomic_variant": true
    },
    "anatomic_variants": [
      "absent_frontal_sinus",
      "concha_bullosa",
      "paradoxical_middle_turbinate",
      "Haller_cell",
      "everted_uncinate_process",
      "agger_nasi_pneumatization"
    ],
    "variant_rule": "Record presence separately; anatomic-variant indicators do not add to the Lund-Mackay sinus score."
  },
  "calculation": {
    "per_side": "Sum five sinus-group scores plus the ipsilateral OMC score.",
    "per_side_range": "0-12",
    "bilateral_total": "right_subtotal + left_subtotal",
    "bilateral_range": "0-24"
  },
  "score_map": [
    {
      "outcome_code": "TOTAL",
      "score": "0-24",
      "interpretation": "Report the exact total; the original system does not define categorical severity bands."
    }
  ],
  "reporting_requirements": [
    "right_subtotal_0_to_12",
    "left_subtotal_0_to_12",
    "bilateral_TOTAL_0_to_24",
    "component_scores",
    "anatomic_variants_separately"
  ],
  "limitations": [
    "Do not convert the 0-24 total into mild, moderate or severe categories; no such thresholds are defined by the original system.",
    "Do not use the CT score alone to diagnose chronic rhinosinusitis or select medical versus surgical treatment."
  ],
  "source_locator": "Lund and Mackay, Rhinology 1993;31:183-184, p.183 radiological staging paragraph and p.184 Table 1; Lund and Kennedy, Otolaryngology-Head and Neck Surgery 1997;117:S35-S40, radiologic grading and absent-frontal-sinus discussion."
}

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