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Radiology of The Ear

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. lateral Oblique (Mastoid)view.

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Radiology of The Ear

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  1. Radiology of The Ear MRI Plain X Ray CT Scan Demonstrates VIII nerve Brain Great vessels Oflimited value Demonstrates Mastoid air cells Accurately demonstrates • External ear • Middle ear • Surrounding structures

  2. lateralOblique (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. lateralOblique (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. External auditory canal TMJ • There is a clean cavity behind and above the external auditiry canal not surrounded by sclerosis • Diagnosis: surgical cavity of mastoidectomy

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

  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 AcuteSinusitis

  16. An air-fluid level AcuteSinusitis

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

  18. Axial view Coronal view CT SCAN

  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. 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 Inverted Papilloma

  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

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