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Paranasal sinuses
Neck
Normal Radiographic Anatomy
Common diseases
Sinusitis
Upper airway obstruction
Paranasal Sinuses
PNSs
PNSs
PNSs are hallow airfills sac line by
mucosa;
Pseudostratified columnar
ciliated epithelium (both
mucinous & serous gland)
Imaging Modality
Interpreration
Sinusitis
PNSs
Four pairs of PNSs
Frontal sinuses
Maxillary sinuses
Ethmoid sinuses
Sphenoid sinuses
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
PNSs
PNSs have small
orifices (ostia), open
into recesses (meatus)
of nasal cavities.
Meati covered by
turbinates (conchae)
Meatus: air space beneath each
conchae
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Imaging Modality
Plain films
Initial Diagnosis or follow up study
Three standard views:
Caldwell view
Water view
Lateral view
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Imaging Modality
Screening Coronal sinus CT
Pre-op For FESS
Extensive polyposis
Suspected osteomyelitis
Persistent symptom after sinus Sx
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Imaging Modality
Magnetic Resonance Imaging
(MRI)
Severe complication
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Plain Radiography
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Caldwell view
Imaging Modality
Interpreration
Sinusitis
Caldwell view
Frontal sinus:
Density < Orbit
Crista galli
Frontal sinus
Ethmoid sinus
Density = air in
inf. Turbinate
Normal Anatomy
Imaging Modality
Ethmoid
sinus
Interpreration
Lamina papyracea
Sinusitis
Water view
(Occipitomeatal view)
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Water view
(Occipitomeatal view)
Frontal sinus
Orbital roof
Anterior ethmoid sinus
Infraorbital
Foramen
Maxillary sinus
Sphenoid sinus
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Water view
(Occipitomeatal view)
Maxillary sinus
Sphenoid sinus
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Lateral view
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Lateral view
Frontal sinus
Roof and
floor of orbit
Sphenoid sinus
Maxillary sinus
Hard Palate
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Interpretation
Shape and Size
Pneumatization
Radiolucency
Sinus clouding
Air fluid level
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Interpretation
Contour
Others
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Sinusitis
Inflammatory process of PNSs
Complication of URI in children (510%)
Maxillary & ethmoid sinuses are
frequently involved
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Sinusitis
Usually follows rhinitis; viral or
allergic
May result from abrupt pressure
changes (air plane, diving) or dental
extraction or infections
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Sinusitis
Inflammation of the linings of the
sinuses and cavities of the nose
The ostia from PNSs to the nose are blocked
Small hairs (cilia) in PNSs that help move the
normally produced mucous out are not working
Too much mucous is produced, often simply a result
of inflammation
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Acute Sinusitis
1 day 4 weeks
Sinus opacification
Bony sinus wall unaffect
Mucosal thickening
paralleling the bony wall
Air-fluid level
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Acute Sinusitis
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Chronic Sinusitis
8-12 wks
Irregular mucosal
thickening
Sinus opacification;
mucosal thickening
or cyst or polyps
Bone change: loss of
mucoperiosteal line
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Chronic Sinusitis
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Imaging Modality
Plain Radiography: Soft tissue
technique
Initial evaluation of soft tissue neck
Define anatomy
Detect Radio-opaque FB
Imaging Modality
Barium swallow
Imaging Modality
CT of the neck with IV contrast
Abscess
Mass/ tumor
MRI
Tumor
Normal Anatomy
Normal Anatomy
Nasopharynx
Oropharynx
Hypopharynx
Adenoid
Oral Cavity
Soft Palate
Epiglottis
Hyoid B.
Cricoid Cartilage
Aryepiglottic fold
Laryngeal Ventricle
Esophagus
Trachea
At C4-7 levels
Expiration
Neck flexion
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Foreign body
Plain Radiography is the first imaging
modality for foreign body detection in
suspicious cases
Best detected radio-opaque foreign
body
If negative plain radiography
Esophagogram
or CT
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Foreign body
Common locations:
Cricopharyngeus muscle 70%
Aortic arch 20%
EG junction 10%
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Adenoid/Tonsils Hyperplasia
Lymphoid tissue of Waldeyers
ring (adenoid, palatine tonsils,
lingual tonsils)
Adenoid: soft tissue in posterior
nasopharynx
Leading cause of Obstructive
Sleep Apnea (OSA) in children
Found in 3-6 yr, absent in adult
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Adenoid/Tonsils Hyperplasia
Enlarged Adenoid
Age dependent
Rarely visible < 6 months
Rapid proliferation during infancy
Peak 2-10 yrs
Size decreased during 2nd decade
Upper limit of normal: 12 mm
Enlarged tonsils
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Retropharyngeal
Space
Along
anterior
prevertebral
space
From base
of the skull
to carina
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Retropharyngeal Abscess
Receive Lymphatic drainage from
nasopharynx, adenoid and posterior
nasal sinus
causes secondary
infection
Common in < 6 yr (50%; 6-12Mo)
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Retropharyngeal Abscess
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Acute Epiglottitis
Serious causes of common upper
airway obstruction in children 3-7
yrs
Causes: Bacterial infection
Most common Haemophilus influenzae type B
Classical triad
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Acute Epiglottitis
Lateral film of neck: Upright
position
Enlargement of epiglottis.
Classic thumb printing sign
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Swollen epiglottis
Impact FB
Adenoid/Tonsils
Endoscopic view
Retroph Abscess
Epiglotitis
Croup
Croup
Croup or Laryngotracheobronchitis
Most common cause of acute stridor
in children
Common 6 Mo - 2 yrs.
Viral infection
Clinical diagnosis
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Croup
Plain film:
Exclude other condition: FB, angioneurotic
edema, epiglottitis or subglottic stenosis
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Dilated hypopharynx (star) & laryngeal ventricle (blue arrow) and subglottic tracheal stenosis (yellow arrow)
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup
Conclusion
PNSs
Plain film: Water, Caldwell, Lateral
Sinusitis
Acute sinusitis: Air-fluid levels, mucosal
thickening, sinus opacification
Chronic sinusitis: Associated bone change
Normal Anatomy
Imaging Modality
Interpreration
Sinusitis
Conclusion
Neck: Upper airway obstruction
Foreign body impaction
Adenoid/tonsil hyperplasia
Retropharyngeal abscess
Epiglottistis
Croup
Impact FB
Adenoid/Tonsils
Retroph Abscess
Epiglotitis
Croup