Imaging in ENT (2)

Modul gangguan THT (S-05)

 Reading an xray

Plain or contrast
Region: mastoid, pns, soft tissue neck
View: AP, lateral, lateral oblique
Anatomical landmarks
Pathological findings
Diagnosis
Plain XRay Mastoid
 Types of Mastoid XRay

15 degree lateral oblique(Law)

30 degree lateral oblique(Schuller): commonly done
45 degree lateral oblique(Myer Owen)
Advantage of schuller & owen: Better visualisation of
key areas of mastoid(attic, aditus, antrum)
Towne’s view: b/l A-P view showing both mastoids &
IAC
 Importance of mastoid xray

Type of pneumatisation: cellular, sclerotic, diploeic

Position of dural plate- look for low lying plate
Position of sinus plate- look for forward lying plate
Presence of bony destruction
Presence of mastoid cavity
Presence of cholesteatoma- cotton wool appearance
 Anatomical landmarks

TM Joint
Ext. auditory canal superimposed on middle ear &
internal acoustic meatus
Mastoid air cells
Dural plate
Sinus plate
 Cellular mastoid

Seen in 80-90 % cases

Defined as presence of plenty of mastoid air cells
Presence of air cells beyond the confines of sinus &
dural plate is called hypercellular mastoid
 Sclerotic mastoid

Absence of mastoid air cells except mastoid antrum

which is smaller in size compared to normal
Seen in chronic otitis media with effusion, CSOM
tubotympanic disease
 Diploeic mastoid

< 1 % cases
Mastoid cavity are mostly
hazy
 Cholesteatoma erosion

Central greyish white shadow- Cotton wool

appearance
Surrounded by radiolucency due to bone destruction
Surrounded by dense white bone of sclerosis
 D/D of Mastoid Cavity

Cholesteatoma (d/t auto mastoidectomy)- smooth

Post mastoidectomy cavity- irregular
Mastoid abscess in coalescent mastoiditis
Tympanomastoid malignancy
Secondary metastasis
Histiocytosis
Eosinophilic granuloma(hairline appearance)
Mega antrum
Tb mastoiditis
Plain Xray of PNS
 Types of PNS X-rays

Occipitomental view(Water’s)
Occipitomental view with mouth open(Pierre)
AP or fronto-occipital view(Caldwell)
Lateral
Lateral oblique of orbit (Rhese) view
Submentovertical view(base skull)
Water’s view
Caldwell view
 Importance of PNS Xray

Look for sinus opacity- should be more dense than

orbital opacity
Look for dome shaped opacity in sinus- maxillary
antral polyp/cyst
Bony opacity- osteoma
Look for fracture
Look for bone destruction- malignancy
Look for radio-opaque foreign body
 Anatomic landmarks

Boundary of frontal sinus

Boundary of maxillary sinus
Ethmoid air cells
Sphenoid sinus(seen through open mouth)
Medial wall of orbit(lamina papyracea)
Innominate line
 Best Xrays for sinus

Maxillary- occipitomental(water’s) view

-best for maxillary sinus
-sinus which is not visible in this?
Frontal – anteroposterior (caldwell) view
-best for frontal sinus
-haustrations are lost in chronic sinusitis
Ethmoid – lateral oblique (Rhese) view
Sphenoid – submento vertical(base skull/ bucket
handle ) view, also shows lesions of palate &
zygomatic arch fractures
Zygoma fracture/ tripod fracture- zygomatico frontal,
zygomatico temporal & infraorbital fractures
Best seen in water’ s view
 Acute sinusitis

Shows air fluid level that moves with change in

position of head
Concave floor
More fluid
Rt. Maxillary sinusitis
 Chronic allergic sinusitis

Xray showing bilateral homogenous opacity of

multiple sinuses
Less fluid,more mucosal thickening or hypertrophy
 D/D of U/L Maxillary opacity

Acute maxillary sinusitis- pus(air fluid level)

Chronic maxillary sinusitis- thick mucosa
Fungal sinusitis
Antrochoanal polyp
Maxillary mucocele
Maxillary antral cyst
Dental cyst(erupted tooth)
Dentigerous cyst(unerupted tooth)
Haemoantrum following trauma
Malignancy- bony outline is lost
Air fluid level
Rt. Antral Polyp
 Antrochoanal polyp

What is the other name?

Parts ?
Etiology ?
Clinical features?
Investigations ?
Treatment ?
 Maxillary malignancy

Etiology ?
Clinical features ?
Investigations?
Treatment ?
 Nasal bone fractures

Clinical features?
Importance of xray?
Treatment?
Instruments for fracture reduction?
Golden period for fracture reduction?
 Nasal foreign body

How to remove it?

Precautions to be taken ?
Importance of an open safety pin?
Clinical features of long standing foreign body nose ?
 Rhinolith

Etiology?
Clinical features?
Investigations?
Treatment ?
Dentigerous cyst
Xray Nasopharynx extended neck
lateral view
 Adenoid

Location?
What is adenoid facies?
Investigation?
Treatment?
Steps of adenoidectomy?
Grisel’s syndrome?
 D/D of nasopharyngeal mass

Adenoid
JNA
Nasopharyngeal carcinoma
Dermoid cyst
Antrochoanal polyp
Xray soft tissue neck A-P &
lateral view
 Anatomic landmarks

Hyoid bone & epiglottis

Laryngeal cartilage calcifications(>40 yrs)
Vocal cords
Pharyngeal air shadow
Tracheal air shadow
Prevertebral soft tissue shadow widening
Cervical vertebral column
 Importance of STN Xray

To look for radioopaque foreign body

Look for acute epiglottitis (thumb sign)
Look for acute laryngotracheobronchitis (croop)
Look for retropharyngeal abscess(prevertebral space
>2/3rd of AP diameter)
Look for cervical vertebrae collapse or fracture
 FB(coin) in cricopharynx

Face of coin seen in AP view & rim of coin seen in

lateral view- FB esophagus
Face of coin seen in lateral view & rim in AP view –
FB Trachea
How to remove it ?
What will happen if we don’t remove it ?
 Importance of lateral view xray?

Confirm position of radio-opaque shadow-

superficial to skin/soft tissue neck/airway/food
passage
Confirm position in relation to cervical vertebrae
Confirm number of foreign body
r/o retropharyngeal abscess
 Open & closed safety pin

Significance of open pin & its direction

Name an instrument for its removal?
 Chronic retropharyngeal abscess

Why cervical spine is straightened?

Radiological findings?
Etiology?
Clinical features?
Treatment?
 TB Spine

Radiological findings?
Etiology?
Clinical features?
Treatment ?
 Foreign body right bronchus

Why does it go into right bronchus?

Clinical features?
Treatment?
 Why do a chest Xray?

Look for radioopaque foreign body

Look for hyperventilated lung
Look for lung collapse
 Acute epiglottitis

Name of this sign?

Etiology?
Clinical features?
Treatment?
 Croup

Name of this sign?

Etiology?
Clinical features?
Treatment?
 Laryngocele

Radiological findings?
Etiology?
Clinical features?
Treatment?
 Submandibular salivary calculus

Radiological findings?
How do you take this xray?
Why stones are more common in submandibular
salivary gland?
Contrast Xrays
Advantage- can see small pouches & constrictions

Contraindication – esophageal perforation, TEfistula

MC used barium sulphate- inert, can be mixed with

food or water, minimal absorption in GIT but acts as
foreign body if leaked out of GIT
 Submandibular sialogram

Radiological findings?
Name of the duct?
How do you take this Xray?
 Branchial fistulogram

Radiological findings?
Etiology?
Clinical features?
Treatment?
 Pharyngeal pouch

Radiological findings?
Etiology?
Clinical features?
Investigations?
Treatment?
 Achalasia cardia

Name of this sign?

Etiology?
Clinical features?
Treatment?
 Oesophageal malignancy

Name of this sign?

Etiology?
Clinical features?
Treatment?
 Oesophageal varices

Name of this sign?

Etiology?
Clinical features?
Treatment?