Limchawalit and Suchato 352 (25): e23, Figure 1 June 23, 2005

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A 35-year-old man was brought to the hospital after sustaining injuries associated with the tsunami in Southeast Asia on December 26, 2004. The patient had inhaled seawater when he nearly drowned. In addition, he had sustained multiple injuries, including a scalp laceration and torn right anterior cruciate and medial collateral ligaments. He had sinus discomfort but no difficulty breathing. Computed tomographic scanning showed fluid and opaque material in the ethmoid (Panel A, arrowhead), maxillary (Panel B, arrowhead), and sphenoid sinuses (Panel C, arrowhead). (For comparison, normally aerated sinuses from another patient can be seen in the Supplementary Appendix, available with the full text of this article at www.nejm.org.) The patient underwent bilateral antral washout, during which green-colored purulent material and sand were removed. Culture of material obtained from the maxillary sinuses showed Aeromonas veronii, Klebsiella pneumoniae, and Escherichia coli on the right side and E. coli, A. hydrophila, and Proteus mirabilis on the left side. The patient received antimicrobial therapy and repair of his right knee ligaments and made a full recovery.