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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
Accurately demonstrates
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
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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
Accurately demonstrates
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
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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
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71-year-old man withdistal esophageal
stricture showsmalignant-appearingstricture (arrows) indistal esophagus.
Narrowed segmenthas markedlyirregular contour +shouldering
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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
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Complete right lung atelectasis
Foreign body Same child after
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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.
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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.
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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.