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Dr.Nurlaily Idris,SpRad Dr.Sri Asriyani,SpRad

Radiology Modality

Ears Plain X-Ray, CT Scan,MRI Nose/sinuses Plain X-Ray, CT Scan,MRI Orbita/eye Plain X-Ray, USG,CT Scan, MRI, Angiografi

Examination for Sinus Paranasalis

1. Convensional Ro:

Occipitomental (Waters position ) sinus maxilla, frontal , sphenoid & os.zygomaticus, septum nasi Occipitofrontal ( Caldwell Position) Frontal, ethmoid, orbita & cavum nasi Lateral Frontal, maxillasphenoid, cavum nasi & nasopharynx

CT Scan/MRI Paranasal sinus , orbita & soft tissue


: Complit partial covering or partial of sinus Air fluid level Thickening of mucosa of sinus ( in allergic case scalloped ) Polip can be found in several cases

Chronic : Athropi of the sinus with polipoid thickening of mucosa Sclerosis with thickening of sinus bones

Obstruction of ostium paranasal sinuses caused acumulation of secret that fulfil the sinus Ro :widening of sinus with covering or erotion of sinus wall or bulging of sinus wall

Complication :
Osteomyelitis : Covering of sinus or loss of sinus wall border - Epidural or cerebral abscess rare but serious CT Scan is the main modality


Benign: Osteoma : Ivory osteoma : radiopaque, yg dense, the border or the tumor is clear, rounded or lobulated, the sinus usually normal (except there is obstruction of ostium) Cancellous osteoma : Radioopak (a little bit high than soft tissue) Papilloma : same image with polip that expand to cavum nasi and the sinus wall became thin.


tumor : (fibroma, neurifibroma, chondroma & osteoch Cholesteatoma : same with mococele Meningocele & encephalocele

Malignant : usually sinus maxillaris Ro : - Soft tissue mass thet fulfil the whole or a part of sinus - Can destruct the bone and expansion to surrounding
CT :- bone destruction more clearly -mass border more clearly -the expansion of tumor more clearly -can detected the necrotic area and abcess



a. b. c.

Normal CT Scan,coronal scan Normal CT Scan , axia scanl CT Scan axial, obliterasi fossa Rossenmuller extra & parafaring area dextra


Plain X-Ray ( Conventional Ro ) - Lateral oblik ( mastoid, meatus ext, middle ear) - PA supraorbital & cantomeatal (Towne Vincent) ( meatus,cochlea,mastoid & anthrum - PA Oblik ( Stenver ) ( mastoid,os. petrous, meatus .acusticus .int, canalsemicir) CT Scan MRI

Acute otitis media & mastoiditis : - Lose of tuba eustachi and meatus acusticus media radiolucensy - anthrum mastoid more radiopaque and covering/ blurred of outter border of mastoid

Chronic Mastoiditis : - Sclerosis of air cells mastoid - Complication of abscess & sequester with sclerotic of mastoid ( difficult to diff with cholesteatoma ) if Abscess the border more clearly - Can caused extradural& intra cerebral sepsis - Can caused serious complication cholesteatoma

Radiology modality : Convensional R : - occipitofrontal projection - lateral projection - oblique, 350 CT-Scan USG M R I Angiography

Conventional X-Ray : - Difficult to detect abnormality of intra & extra ocular except if there are radiopaque density, can detect fracture - CT-Scan main modality

Calsification Rare on soft tisue, but if found significant sign and patognomonis for some conditions as : - Catarac - Retrolental fibroplasia - Retinoblastoma

Cataract sirculer calsification in lens, 7 mm (PA) Retrolental fibroplasia little calsification intravitreal, in advance condition can found with lenticuler Retinoblastoma spotted calsification that union, and found bilateral

The others calsification can also caused by: - Angioma - Hematoma - Aneurisma - AVM - Meningioma - Kavernous hemangioma - Glioma



Dermoid & Epidermoid : Usually in superolateral orbita with sclerotic border Glandula lacrimal tumor Ca.Nasofaring & sinus paranasalis

CT : coronal/axial - Thickening of extra okuler muscle - hipertrofi orbital fat - edema interstitial of konjungtiva - degenerasi ekstraokuler muscles

Celulitis Usually caused by sinusitis & trauma osteomielitis, septik tromboplebitis, meningitis, dll. Plain X Ray : opaque on sinus, destruksi of bones caused by osteomielitis.

CT-Scan : - Can be found abses formation ( mass with unclear border with enhancement) - Udema preseptal soft tissue - Udema outline retrobulber structur - Opague pd sinus paranasalis (radang/mass) M R I same with CT Scan, but MRI can make more different positions & conditions