Xrays in ent- Dr Ashly Alexander

xrays in ent, ent radiology, xrays in otorhinolaryngology, xray mastoid, xray pns, xray soft tissue neck, xray nasopharynx, contrast xrays

1. DR ASHLY ALEXANDER ENT PG RESIDENT GMC,BHOPAL XRAYS IN ENT

2. Reading an xray Plain or contrast Region: mastoid, pns , soft tissue neck View: AP, lateral, lateral oblique Anatomical landmarks Pathological findings Diagnosis

3. Plain XRay Mastoid

4. 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

5. 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

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

7. 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

8. 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

9. Diploeic mastoid < 1 % cases Mastoid cavity are mostly hazy

10. Cholesteatoma erosion Central greyish white shadow- Cotton wool appearance Surrounded by radiolucency due to bone destruction Surrounded by dense white bone of sclerosis

11. 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

12. Plain Xray of PNS

13. 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)

14. Water’s view

15. Caldwell view

16. 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

17. 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

18. 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

19. Zygoma fracture/ tripod fracture- zygomatico frontal, zygomatico temporal & infraorbital fractures Best seen in water’ s view

20. Acute sinusitis Shows air fluid level that moves with change in position of head Concave floor More fluid

21. Rt. Maxillary sinusitis

22. Chronic allergic sinusitis Xray showing bilateral homogenous opacity of multiple sinuses Less fluid,more mucosal thickening or hypertrophy

23. 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

24. Air fluid level

25. Rt. Antral Polyp

26. Antrochoanal polyp What is the other name? Parts ? Etiology ? Clinical features? Investigations ? Treatment ?

27. Maxillary malignancy Etiology ? Clinical features ? Investigations? Treatment ?

28. Nasal bone fractures Clinical features? Importance of xray ? Treatment? Instruments for fracture reduction? Golden period for fracture reduction?

29. 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 ?

30. Rhinolith Etiology ? Clinical features? Investigations? Treatment ?

31. Dentigerous cyst

32. Xray Nasopharynx extended neck lateral view

33. Adenoid Location? What is adenoid facies ? Investigation? Treatment? Steps of adenoidectomy? Grisel’s syndrome?

34. D/D of nasopharyngeal mass Adenoid JNA Nasopharyngeal carcinoma Dermoid cyst Antrochoanal polyp

35. Xray soft tissue neck A-P & lateral view

36. 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

37. 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 >2/3 rd of AP diameter) Look for cervical vertebrae collapse or fracture

38. 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 ?

39. 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

40. Open & closed safety pin Significance of open pin & its direction Name an instrument for its removal?

41. Chronic retropharyngeal abscess Why cervical spine is straightened? Radiological findings? Etiology ? Clinical features? Treatment?

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

43. Foreign body right bronchus Why does it go into right bronchus? Clinical features? Treatment?

44. Why do a chest Xray ? Look for radioopaque foreign body Look for hyperventilated lung Look for lung collapse

45. Acute epiglottitis Name of this sign? Etiology ? Clinical features? Treatment?

46. Croup Name of this sign? Etiology ? Clinical features? Treatment?

47. Laryngocele Radiological findings? Etiology ? Clinical features? Treatment?

48. Submandibular salivary calculus Radiological findings? How do you take this xray ? Why stones are more common in submandibular salivary gland?

49. Contrast Xrays

50. 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

51. Submandibular sialogram Radiological findings? Name of the duct? How do you take this Xray ?

52. Branchial fistulogram Radiological findings? Etiology ? Clinical features? Treatment?

53. Pharyngeal pouch Radiological findings? Etiology ? Clinical features? Investigations? Treatment?

54. Achalasia cardia Name of this sign? Etiology ? Clinical features? Treatment?

55. Oesophageal malignancy Name of this sign? Etiology ? Clinical features? Treatment?

56. Oesophageal varices Name of this sign? Etiology ? Clinical features? Treatment?