CT Scan

MRI

Plain X Ray

Accurately demonstrates External ear Middle ear Surrounding structures

Demonstrates VIII nerve Brain Great vessels

Of limited value
Demonstrates Mastoid air cells

 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

 lateral Oblique (Mastoid)

TMJ

External auditory canal

Pneumatised mastoid: air spaces separated by bony partitions

 The mastoid cells (white arrow) are obscured, and not air-containing, due to chronic otitis media.
External auditory canal

TMJ

 Schller 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

TMJ
There is a clean cavity behind and above the external auditiry canal not surrounded by sclerosis Diagnosis: surgical cavity of mastoidectomy

External auditory canal

Petrous bone

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

 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.

 Axial CT scans: Transverse temporal bone fracture (arrows).

CT Scan
Accurately demonstrates Nose Paranasal sinuses Surrounding structures

MRI

Plain X Ray
limited value Screening of sinuses Medico-legal
IN NASAL BONE FRACTURE

Mainly for Surrounding soft tissue structures

 Patient facing the film Radiologic base line tilted 450 Beam horizontal , directed to external occipital protuberance

Frontal sinus

orbit
septum

Maxillary sinus

Maxillary sinus

Sphenoid sinus

NB
Radiologic Examination of sinuses should be: - In erect position - Sphenoid is seen in occipitomental view with open mouth

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

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

Acute Sinusitis

 Acute Sinusitis

NASAL FRACTURE

Loss of continuity of nasal bone with displacement of distal fragment

 Axial view Coronal view

Coronal CT scan Normal 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

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

ORBIT Ethmoid

Maxillary

Maxillary

Sphenoid Sinus - Divided by a septum into right and left sinuses - The floor of the sinus is the roof of the nasopharynx

Sphenoid

Orbit

Bulla Ethmoidalis Middle Maxillary Turbinate Sinus Middle Meatus Uncinate process

Inferior Turbinate Inferior Meatus

PATHOLOGICAL FINDINGS

CORONAL CT SHOWING THICKENING OF THE FRONTAL SINUS MUCOSA

Osteoma. A left frontal osteoma ( arrow) is

visible anteriorly in this coronal CT scan. Note its increased density, characteristic of the lesion.

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

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

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

Coronal CT scan Blocked ostiomeatal complex

Maxillary sinus

Maxillary sinus

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

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

 Coronal CT scan
Concha bullosa i.e pneumatized middle
turbinate

A deviated nasal septum.

Concha bullosa i.e pneumatized middle

turbinate ( red arrow).

orbit
orbit

Maxillary sinus

Pardoxical middle turbinates.

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

 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)

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

Oroantral fistula
Enumerate 3 causes starting with the most common cause

Comment

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

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

 Coronal CT scan Bilateral sphenoidal sinus opacity Diagnosis: Bilateral Sphenoid sinusitis

There is soft-tissue thickening AxialFrontal sinuses left CT scan over the expanded Right Frontal Sinus expansion are partially opacified of mucoperiosteal thickening by the Right Frontal sinus.

??

Hyperdense sinus secretions. This axial CT scan shows hyperdense secretions in the left maxillary antrum. fungal sinusitis.

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

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

 Axial MRI scan showing opacification of the left maxillary sinus

CT Scan

Barium swallow

Plain X Ray

Accurately demonstrates Pharynx Surrounding srtucture with LN

The lumen ++

limited value demonstrates Lumen of pharynx

 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)

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

 Widening of the radiological pre-vertebral space Acute Retropharyngeal abscess

wide prevertebral space (blue arrow) pushing the airway anteriorly (yellow arrow) in the lower half of the neck
Hypopharyngeal mass

Retropharyngeal abscess
Notice the markedly thickened prevertebral soft tissue space (between arrows) Notice the destruction of 5th &6th cervical vertebra Potts Disease

Potts Disease

 Safety pin in hypopharynx

 Coins are probably the most commonly ingested foreign bodies in children

 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

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

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

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

 A pouch in the lower neck filled with radioopaque dye

Pharyngeal pouch

CT Scan

Barium swallow

Plain X Ray

Accurately demonstrates The esophagus Surrounding srtucture with LN

demonstrates
The lumen +++

Radio-opaque foreign body

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)

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

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.

Carcinoma of oesphagus The stricture is -irregular -short -shouldering prestenotic dilatation is

moderate

 71-year-old man with distal esophageal stricture shows malignant-appearing stricture (arrows) in distal esophagus. Narrowed segment has markedly irregular contour + shouldering

Post corrosive stenosis The stricture is

- Long segment - Conical beginning - High above the cardia The pre-stenotic dilatation is small

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

 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.

 Chest radiograph of a child with no abnormality identified

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

 Complete right lung atelectasis

 Foreign body Collapsed left lung

Same child after extraction of the foreign body showing re-expansion of the left lung

 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.

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

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

 Clinical presentation: Child 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.

 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.