6 Radiology Under Graduate

7/31/2019 6 Radiology Under Graduate

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CT Scan MRI PlainX Ray

Accurately demonstrates

External ear

Middle ear

Surrounding structures

DemonstratesVIII nerve

Brain

Great vessels

Oflimited valueDemonstrates

Mastoid air cells


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Locate the Temporo-mandibular jointthe external auditory canal (EAC)

which is a complete circle

The mastoid air cells are behind and

above the EAC

lateralOblique (Mastoid)view


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TMJ

Pneumatised mastoid:air spaces separatedby bony partitions

External auditory

canal

lateralOblique (Mastoid)


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The mastoid cells (white arrow) areobscured, and not air-containing,

due to chronic otitis media.

TMJ

External

auditory canal


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Schller view: Well-developed normallypneumatized mastoid air cells can be observedin the picture on the left side (double arrow).

In the picture on the right side, the mastoid cells(arrow) are obscured, and not air-containing, dueto chronic otitis media.

TMJ

EACSinodural angle


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There is a cleancavity behind andabove the external

auditiry canal notsurrounded bysclerosis

Diagnosis:

surgical cavity ofmastoidectomy

TMJExternal auditory

canal


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Axial CT scan, the destructed apex of thepetrous bone can be observed (white arrow),which is caused by ? cholesteatoma.

Petrous bone


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Axia CT scans:

The mastoid cells on the right side (green arrow)

are totally obscured, which proves mastoiditis. On the left side (blue arrow), an intact status can

be seen.


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Axial CT scans:

Transverse temporal bone fracture (arrows).


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CT Scan MRI PlainX Ray

Accurately demonstrates Nose

Paranasal sinuses

Surrounding

structures

Mainly for

Surrounding soft

tissue structures

limited value

Screening of sinuses

Medico-legalIN NASAL BONE

FRACTURE


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Patient facing thefilm

Radiologic baseline tilted 450

Beam horizontal ,

directed toexternal occipitalprotuberance


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septum

orbit

Maxillary

sinus

Frontal

sinus

Sphenoid

sinus

Maxillary

sinus


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NB

Radiologic Examination of sinusesshould be:

- In erect position- Sphenoid is seen in occipitomental

view with open mouth


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Frontal SinusEthmoid Sinus

Maxillary Sinus

Soft PalateNasopharynx

Sphenoid Sinus

Sella TurcicaClinoid Process


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Occipito-mental view of the sinusesshowing partial opacification of the right

maxillary sinus, with an air-fluid level

AcuteSinusitis


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AcuteSinusitis


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NASAL FRACTURE

Loss of continuityof nasal bone withdisplacement ofdistal fragment


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Axial view Coronal view


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Coronal CT scanNormal findings

The sinusesnormally contain airwhich is seen inblack color

The frontal sinus :

- Above the orbit

- Seen in the anteriorcuts

- May be absent

ORBIT ORBIT


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Ethmoid sinuses

- 15 to 20 air cells ineach side

- Medial to Laminapaparycea

Maxillary sinus- Below the orbit

Ethmoid

MaxillaryMaxillary

ORBIT


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Sphenoid Sinus

- Divided by aseptum into rightand left sinuses

- The floor of thesinus is the roof ofthe nasopharynx

Sphenoid


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MiddleTurbinate

Inferior Turbinate

Uncinateprocess

Middle Meatus

Maxillary Sinus

BullaEthmoidalis

Orbit

Inferior Meatus


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PATHOLOGICAL FINDINGS


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CORONAL CT

SHOWING

THICKENING OFTHE FRONTAL

SINUS MUCOSA


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Osteoma. A left frontal osteoma ( arrow) isvisible anteriorly in this coronal CT scan.Note its increased density, characteristicof the lesion.


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Coronal CT scan showing normalostiomeatal complex. Patent ostia are

visible on both sides, and sinuses are wellventilated.


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Coronal CT scan Total ethmoid opacity ( ethmoidal polypi) Fluid level in the left maxillary sinus Diagnosis : bilateral ethmoid sinusitis Left

maxillary sinusitis


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Coronal CT scan

Blocked osteomeatal complex

Opacity of right ethmoidal air cells

Fluid level in the left maxillary sinus

Thickened mucosa of right maxillary sinus

Diagnosis: bilateral Maxillary sinusitis, right ethmoid sinusitis


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Coronal CT scanBlocked ostiomeatal complex

Maxillary

sinus Maxillarysinus


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A coronal CT scan

Moderate bilateral maxillary sinus mucosal thickening withblockage of both ostiomeatal complexes

Chronic sinusitis


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A coronal CT scan.

Complete opacification of the right maxillary sinus

Mucosal thickening of the left maxillary sinus

Chronic sinusitis


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Coronal CT scan

Concha bullosa i.e pneumatized middleturbinate

A deviated nasal septum.


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Concha bullosa i.e pneumatized middleturbinate ( red arrow).

orbit

orbit

Maxillary

sinus


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Pardoxical middle turbinates.


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Coronal CT scan

Bilateral total opacity of ethmoid sinuses

Bilateral Ethmoidal polypi


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Coronal CT scan showing right maxillary sinusopacification. Also, note the septal deviation tothe right and the hypertrophy of the left inferior

turbinate (yellow arrow)


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Coronal CT scan ofthe sinuses showingbilateral maxillarysinusitis.

The opacification is

more prominent onthe left side (arrow).


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Oroantral fistula Enumerate 3 causes starting with the most

common cause


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Comment


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Complete right maxillary sinus opacity

Opacity and Widening of the rightosteomeatal complex

Soft tissue opacity in the nasopharynx


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Inverted Papilloma

Soft tissue mass in thenasal cavity and leftmaxillary and ethmoidalsinuses

The left middle meatusand medial wall of theleft maxillary sinus areabsent.

There is mucosal

thickening of the rightmaxillary sinus

DifferentialDiagnosis

Inverted papilloma

Antrochoanal polypSquamous cell

carcinoma


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Coronal CT scan

Bilateralsphenoidal sinusopacity

Diagnosis:Bilateral Sphenoidsinusitis


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left Frontal sinusesare partially opacified

by mucoperiosteal thickening

There is soft-tissue thickening

over the expanded Right Frontal Sinusexpansionof the Right Frontal sinus.

Axial CT scan

??

H d i i Thi i l CT


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Hyperdense sinus secretions. This axial CT

scan shows hyperdense secretions in the left

maxillary antrum. fungal sinusitis.

Si l l i


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Sinonasal polyposis.

Note the polypoid changes with opacification and

expansion of the right Nasal cavity, right maxillary

sinusitis coexists.


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MRI

Coronal MRIscan showingopacification ofthe left maxillaryand ethmoidsinuses


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Axial MRI scan

showingopacification of theleft maxillary sinus


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CT ScanBarium

swallow PlainX Ray


Pharynx

Surrounding srtucture

with LN

The lumen ++

limited value

demonstrates

Lumen of pharynx


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Lateral soft tissue X ray

of the head and neck

Soft tissue shadowarising from the roofand posterior wall of

the nasopharynxindenting thenasopharyngeal airway(green arrow)

Suggesting adenoid( blue arrow)


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Lateral view of the Neck

Look for- The vertebral column

( for any destructione.g in Potts disease)

- The pre-vertebralspace (3/4 the widthof the body of thevertebra)

- The airway


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Widening of the radiological pre-vertebral space

Acute Retropharyngeal abscess


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wide prevertebral space (blue arrow)pushing the airway anteriorly (yellow

arrow) in the lower half of the neck

Hypopharyngeal mass


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Retropharyngeal abscess

Notice the markedlythickened prevertebral softtissue space(betweenarrows)

Notice the destruction of 5th&6th cervical vertebra

Potts Disease


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Potts Disease
http://rds.yahoo.com/_ylt=A9iby4DuzWlFMP4AtxeJzbkF;_ylu=X3oDMTBjMzRvMDBnBHBvcwM5BHNlYwNzcg--/SIG=1hk7i786d/EXP=1164648302/**http%3a//images.search.yahoo.com/search/images/view%3fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253F_adv_prop%253Dimages%2526imgsz%253Dall%2526imgc%253D%2526vf%253Dall%2526va%253Dpott%252527s%252Bdisease%2526fr%253Dslv8-msgr%2526ei%253DUTF-8%26w=480%26h=640%26imgurl=www.wheelessonline.com%252Fimage6%252Fcstb1.jpg%26rurl=http%253A%252F%252Fwww.wheelessonline.com%252Fortho%252Ftuberculous_spondylitis%26size=15.2kB%26name=cstb1.jpg%26p=pott%2527s%2bdisease%26type=jpeg%26no=9%26tt=14%26oid=f656c068fd2497ac%26ei=UTF-8


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Safety pin in hypopharynx

C i b bl h l


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Coins are probably the most commonlyingested foreign bodies in children


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AP and lateral plain films showing ametallic foreign body in the upper

esophagus. Most foreign bodies are foundat the level of the cricopharyngeus muscle

Chest X Ray showing the metallic hook of the


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Chest X-Ray showing the metallic hook of thepartial denture (right). The rest of the plate isradiolucent.


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Coin shaped shadow is seen in the lower neckand above the level of the clavicle. SwallowedCoin is seen by esophagoscopy

L t l di h f th k l t li


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Lateral radiograph of the neck reveals metalicforeign body in the hypopharynx


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Pharyngeal pouch

A pouch in the lower neck filled with radio-

opaque dye


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CT ScanBarium

swallow

Plain

X Ray


The esophagus

Surrounding srtucture

with LN

demonstrates

The lumen +++

Radio-opaque

foreign body


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Barium Swallow

Look for

Stricture

- length

- regular or irregular

- beginning,( e.g conical , shouldering

- Site ( at or high above the cardia)Pre-stenotic dilatation( small, moderateor huge dilatation)

A h l i


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Achalasia

The stricture is

1-smooth

2- conical

3- at the cardia

Pre-stenotic

dilatation is huge

Achalasia
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/med/images/Large/319bariumswallow.jpg&template=izoom2


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Achalasia

This 63 year old man

presented with a long historyof dysphagia, regurgitation ofundigested food and anocturnal cough.

Barium swallow showsmarked dilatation of theesophagus above thesmooth tapering lower end

Endoscopy showed a largevolume of food residuewithin the oesophagus. Themucosa appeared normal.


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Carcinoma ofoesphagus

The stricture is-irregular-short-shoulderingprestenotic

dilatationismoderate
http://www.ajronline.org/content/vol180/issue3/images/large/03_AC0808_06.jpeg


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71-year-old man withdistal esophageal

stricture showsmalignant-appearingstricture (arrows) indistal esophagus.

Narrowed segmenthas markedlyirregular contour +shouldering
http://www.ajronline.org/content/vol180/issue3/images/large/03_AC0808_06.jpeg


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The stricture is

- Long segment

- Conical beginning

- High above the

cardiaThe pre-stenotic

dilatation is small

Post corrosive

stenosis


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The majority of children who aspirate a foreign

body are in the pre-school age group (1 to 5years).

The most common foreign bodies are nuts butany other objects about the size of a peanut

can be inhaled (eg beads, plastic toys). Many children will not have a history of a

choking episode, however, a history of acute

choking, cough, breathlessness or wheezemay all indicate inhalation of a foreign body.

Chest radiograph of a child with no


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Chest radiograph of a child with noabnormality identified

PA chest,


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PA chest,

Diagnosis : Right lung collapse

? FB in the right main bronchus

C l i h l l i
http://kobiljak.msu.edu/CAI/RAD553/Slide_Set_7/Images/Slide06.jpg


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Complete right lung atelectasis

Foreign body Same child after
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/med/images/Large/1715atelectr.jpg&template=izoom2


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Foreign body

Collapsed left lung

Same child afterextraction of theforeign body showing

re-expansion of theleft lung

Expiratory chest radiograph. Air trapping in the left


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p y g p pp glung prevents air being expelled during expiration sothe left lung remains more lucent (darker) and themediastinum shifts to the right as the right lung

decreases in volume normally.
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/emerg/images/Large/59TFB3%2EJPG&template=izoom2


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A tooth (molar) was

dislodged duringintubation. Thepatient developed a

lobar pneumoniafrom the tooth,

Aspirated foreign body (backing to an


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p g y ( gearring) lodged in the right main stembronchus

Clinical presentation:Child admitted with breathing problems after playing with


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Child admitted with breathing problems after playing withplastic toy and a small piece is now missing.

The right lung volume is increased and has herniated

across the mid-line. The left lung is compressed by thedisplaced heart and mediastinum.
http://myweb.lsbu.ac.uk/dirt/museum/margaret/68--7521-2320240.jpg


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This patient was able to speak, in

spite of the fact that she had anuncapped tracheostomy tube. Asuction catheter could not beintroduced more than a few inchesbefore meeting resistance.

The picture above is a sagittalreformatting of a neck CT scan thatshows the tracheotomy cannula ina false tract, outside the trachea.

The axial CT scan picture below

shows the same tracheostomycannula anterior to the trachea.

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6 Radiology Under Graduate