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Radiology of The Ear

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Locate the Temporo-mandibular joint the external auditory canal ... Beam horizontal , directed to external occipital protuberance. Occipito-mental projection ... – PowerPoint PPT presentation

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Title: Radiology of The Ear


1
  • Radiology of The Ear

MRI
Plain X Ray
CT Scan
Demonstrates VIII nerve Brain Great vessels
Of limited value Demonstrates Mastoid air cells
  • Accurately demonstrates
  • External ear
  • Middle ear
  • Surrounding structures

2
  • lateral Oblique (Mastoid)view
  • Locate the Temporo-mandibular joint the external
    auditory canal (EAC) which is a complete circle
  • The mastoid air cells are behind and above the EAC

3
  • lateral Oblique (Mastoid)

TMJ
External auditory canal
Pneumatised mastoid air spaces separated by bony
partitions
4
  • The mastoid cells (white arrow) are obscured, and
    not air-containing, due to chronic otitis media.

External auditory canal
TMJ
5
  • Schüller view Well-developed normally
    pneumatized mastoid air cells can be observed in
    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, due to chronic otitis media.

TMJ
Sinodural angle
EAC
6
TMJ
External auditory canal
  • There is a clean cavity behind and above the
    external auditiry canal not surrounded by
    sclerosis
  • Diagnosis surgical cavity of mastoidectomy

7
Petrous bone
  • Axial CT scan, the destructed apex of the petrous
    bone can be observed (white arrow), which is
    caused by ? cholesteatoma.

8
  • 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.

9
  • Axial CT scans
  • Transverse temporal bone fracture (arrows).

10
  • imaging of the nose
  • MRI

Plain X Ray
CT Scan
  • Accurately demonstrates
  • Nose
  • Paranasal sinuses
  • Surrounding
  • structures

Mainly for Surrounding soft tissue structures
limited value Screening of sinuses Medico-legal
IN NASAL BONE FRACTURE
11
  • Occipito-mental projection
  • Patient facing the film
  • Radiologic base line tilted 450
  • Beam horizontal , directed to external occipital
    protuberance

12
Frontal sinus
orbit
  • septum

Maxillary sinus
Maxillary sinus
Sphenoid sinus
13
NB
  • Radiologic Examination of sinuses should be
  • In erect position
  • Sphenoid is seen in occipitomental view with open
    mouth

14
  • Frontal Sinus
  • Ethmoid Sinus
  • Maxillary Sinus
  • Soft Palate
  • Nasopharynx
  • Sphenoid Sinus
  • Sella Turcica
  • Clinoid Process

15
  • Occipito-mental view of the sinuses showing
    partial opacification of the right maxillary
    sinus, with an air-fluid level
  • Acute Sinusitis

16
  • An air-fluid level
  • Acute Sinusitis

17
NASAL FRACTURE
  • Loss of continuity of nasal bone with
    displacement of distal fragment

18
  • CT SCAN
  • Axial view
  • Coronal view

19
Coronal CT scanNormal findings
  • The sinuses normally contain air which is seen in
    black color
  • The frontal sinus
  • Above the orbit
  • Seen in the anterior cuts
  • May be absent
  • ORBIT
  • ORBIT

20
  • Ethmoid sinuses
  • 15 to 20 air cells in each side
  • Medial to Lamina paparycea
  • Maxillary sinus
  • - Below the orbit
  • ORBIT

Ethmoid
Maxillary
Maxillary
21
  • Sphenoid Sinus
  • Divided by a septum into right and left sinuses
  • The floor of the sinus is the roof of the
    nasopharynx

Sphenoid
22
Orbit
Bulla Ethmoidalis
Middle Turbinate
Maxillary Sinus
Middle Meatus
Uncinate process
Inferior Turbinate
Inferior Meatus
23
PATHOLOGICAL FINDINGS
24
  • CORONAL CT
  • SHOWING
  • THICKENING OF
  • THE FRONTAL
  • SINUS MUCOSA

25
  • Osteoma. A left frontal osteoma ( arrow) is
    visible anteriorly in this coronal CT scan. Note
    its increased density, characteristic of the
    lesion.

26
  • Coronal CT scan showing normal ostiomeatal
    complex. Patent ostia are visible on both sides,
    and sinuses are well ventilated.

27
  • Coronal CT scan
  • Total ethmoid opacity ( ethmoidal polypi)
  • Fluid level in the left maxillary sinus
  • Diagnosis bilateral ethmoid sinusitis Left
    maxillary sinusitis

28
  • 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

29
  • Coronal CT scan
  • Blocked ostiomeatal complex

Maxillary sinus
Maxillary sinus
30
  • A coronal CT scan
  • Moderate bilateral maxillary sinus mucosal
    thickening with blockage of both ostiomeatal
    complexes
  • Chronic sinusitis

31
  • A coronal CT scan.
  • Complete opacification of the right maxillary
    sinus
  • Mucosal thickening of the left maxillary sinus
  • Chronic sinusitis

32
  • Coronal CT scan
  • Concha bullosa i.e pneumatized middle turbinate
  • A deviated nasal septum.

33
  • Concha bullosa i.e pneumatized middle turbinate
    ( red arrow).

orbit
orbit
Maxillary sinus
34
  • Pardoxical middle turbinates.

35
  • Coronal CT scan
  • Bilateral total opacity of ethmoid sinuses
  • Bilateral Ethmoidal polypi

36
  • Coronal CT scan showing right maxillary sinus
    opacification.  Also, note the septal deviation
    to the right and the hypertrophy of the left
    inferior turbinate (yellow arrow)

37
  • Coronal CT scan of the sinuses showing bilateral
    maxillary sinusitis. 
  • The opacification is more prominent on the left
    side (arrow).

38
  • Oroantral fistula
  • Enumerate 3 causes starting with the most common
    cause

39
  • Comment

40
  • Complete right maxillary sinus opacity
  • Opacity and Widening of the right osteomeatal
    complex
  • Soft tissue opacity in the nasopharynx

41
Inverted Papilloma
  • Soft tissue mass in the nasal cavity and left
    maxillary and ethmoidal sinuses
  • The left middle meatus and medial wall of the
    left maxillary sinus are absent.
  • There is mucosal thickening of the right
    maxillary sinus
  • Differential Diagnosis
  • Inverted papilloma
  • Antrochoanal polyp
  • Squamous cell
  • carcinoma

42
  • Coronal CT scan
  • Bilateral sphenoidal sinus opacity
  • Diagnosis Bilateral Sphenoid sinusitis

43
  • Axial CT scan

44
There is soft-tissue thickening over the
expanded Right Frontal Sinus
??
left Frontal sinuses are partially opacified
by mucoperiosteal thickening
Axial CT scan
expansion of the Right Frontal sinus.
45
  • Hyperdense sinus secretions. This axial CT
  • scan shows hyperdense secretions in the left
  • maxillary antrum. fungal sinusitis.

46
  • Sinonasal polyposis.
  • Note the polypoid changes with opacification and
  • expansion of the right Nasal cavity, right
    maxillary
  • sinusitis coexists.

47
MRI
  • Coronal MRI scan showing opacification of the
    left maxillary and ethmoid sinuses

48
  • Axial MRI scan showing opacification of the left
    maxillary sinus

49
  • imaging of the pharynx

50
Barium swallow
Plain X Ray
CT Scan
  • Accurately demonstrates
  • Pharynx
  • Surrounding srtucture
  • with LN

The lumen
limited value demonstrates Lumen of pharynx
51
  • Lateral soft tissue X ray of the head and neck
  • Soft tissue shadow arising from the roof and
    posterior wall of the nasopharynx indenting the
    nasopharyngeal airway (green arrow)
  • Suggesting adenoid
  • ( blue arrow)

52
Lateral view of the Neck
  • Look for
  • The vertebral column ( for any destruction e.g in
    Potts disease)
  • The pre-vertebral space (3/4 the width of the
    body of the vertebra)
  • The airway

53
  • Widening of the radiological pre-vertebral space
  • Acute Retropharyngeal abscess

54
wide prevertebral space (blue arrow) pushing the
airway anteriorly (yellow arrow) in the lower
half of the neck Hypopharyngeal mass
55
Retropharyngeal abscess
  • Notice the markedly thickened prevertebral soft
    tissue space (between arrows)
  • Notice the destruction of 5th 6th cervical
    vertebra
  • Potts Disease

56
Potts Disease
57
  • Safety pin in hypopharynx

58
  • Coins are probably the most commonly ingested
    foreign bodies in children

59
  • AP and lateral plain films showing a metallic
    foreign body in the upper esophagus.  Most
    foreign bodies are found at the level of the
    cricopharyngeus muscle

60
  • Chest X-Ray showing the metallic hook of the
    partial denture (right). The rest of the plate is
    radiolucent.

61
  • Coin shaped shadow is seen in the lower neck and
    above the level of the clavicle. Swallowed Coin
    is seen by esophagoscopy

62
  • Lateral radiograph of the neck reveals metalic
    foreign body in the hypopharynx

63
  • A pouch in the lower neck filled with
    radio-opaque dye

Pharyngeal pouch
64
  • Imaging of the esophagus

65
Barium swallow
Plain X Ray
CT Scan
demonstrates The lumen
Radio-opaque foreign body
  • Accurately demonstrates
  • The esophagus
  • Surrounding srtucture
  • with LN

66
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, moderate or
    huge dilatation)

67
Achalasia
  • The stricture is
  • 1-smooth
  • 2- conical
  • 3- at the cardia
  • Pre-stenotic
  • dilatation is huge

68
Achalasia
  • This 63 year old man presented with a long
    history of dysphagia, regurgitation of undigested
    food and a nocturnal cough.
  • Barium swallow shows marked dilatation of the
    esophagus above the smooth tapering lower end
  •  
  • Endoscopy showed a large volume of food residue
    within the oesophagus.  The mucosa appeared
    normal. 

69
Carcinoma of oesphagusThe stricture
is-irregular-short-shoulderingprestenotic
dilatation is moderate
70
  • 71-year-old man with distal esophageal stricture
    shows malignant-appearing stricture (arrows) in
    distal esophagus.
  • Narrowed segment has markedly irregular contour
    shouldering

71
Post corrosive stenosis
  • The stricture is
  • Long segment
  • Conical beginning
  • High above the cardia
  • The pre-stenotic
  • dilatation is small

72
  • Trachea

73
  • Child with croup. Note the pencil sign of the
    proximal trachea evident on this anteroposterior
    film

74
  • The majority of children who aspirate a foreign
    body are in the pre-school age group (1 to 5
    years).
  • The most common foreign bodies are nuts but any
    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 wheeze may all
    indicate inhalation of a foreign body.

75
  • Chest radiograph of a child with no abnormality
    identified

76
  • PA chest,
  • Diagnosis Right lung collapse
  • ? FB in the right main bronchus

77
  • Complete right lung atelectasis

78
  • Same child after extraction of the foreign body
    showing re-expansion of the left lung
  • Foreign body
  • Collapsed left lung

79
  • Expiratory chest radiograph. Air trapping in the
    left lung prevents air being expelled during
    expiration so the left lung remains more lucent
    (darker) and the mediastinum shifts to the right
    as the right lung decreases in volume normally.

80
  • A tooth (molar) was dislodged during intubation.
    The patient developed a lobar pneumonia from the
    tooth,

81
  • Aspirated foreign body (backing to an earring)
    lodged in the right main stem bronchus

82
  • Clinical presentationChild admitted with
    breathing problems after playing with plastic 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 the displaced heart and
    mediastinum.

83
  • This patient was able to speak, in spite of the
    fact that she had an uncapped tracheostomy tube.
     A suction catheter could not be introduced more
    than a few inches before meeting resistance.  
  • The picture above is a sagittal reformatting of a
    neck CT scan that shows the tracheotomy cannula
    in a false tract, outside the trachea.  
  • The axial CT scan picture below shows the same
    tracheostomy cannula anterior to the trachea.  
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