Ent radiology
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This document provides information on various radiographic views and examinations of the head and neck region. It discusses Water's view for imaging the maxillary sinuses, basic positioning for paranasal sinus views, Caldwell's view for the ethmoid and frontal sinuses, and examples of common sinus findings on radiography like mucosal thickening and retention cysts. It also summarizes techniques for imaging the nasopharynx, neck, cervical spine, trachea, and larynx. Common foreign body locations and aspiration findings are outlined. Sialography for salivary gland evaluation and bronchography are briefly described. Finally, it reviews skull radiographic views like PA, Caldwell, Chamberlain-Townes, and lateral projections as
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Ent radiology
- 2. Water's - best for maxillary sinus (Ethmoids and frontals too far from film) 45
- 3. Basic Patient Position The patient sits erect facing the bucky, midsagittal plane in the midline of the film, coronal plane parallel to the film interpupillary line parallel to the floor. The chin is raised to bring the orbital meatal line at 45 degrees to the film. In some centers the patient is imaged mouth open to demonstrate the sphenoid sinuses.
- 5. Caldwell best for ethmoids and frontal sinus (Temporal bones overlie maxillary)
- 8. Xray PNS Water’s view showing • Opacity in B/L maxillary sinuses • Diagnosis: – B/L Maxillary sinusitis
- 9. Xray PNS Water’s view showing • Opacity in Right maxillary sinus • Diagnosis: – Rt. Maxillary sinusitis
- 10. Xray PNS Water’s view showing • Radiodense lesion / opacity in Left maxillary sinus & Left nasal cavity • Diagnosis: – Lt. AntroChoanal Polyp
- 11. Xray of PNS – Water’s view showing Rt. Antral Polyp • Opacity seen in Rt. Maxillary sinus • Convexity upwards
- 12. Xray PNS Water’s view showing • Opacity seen in Rt. Maxillary sinus • Tooth on the medial wall • Thinned out Sinus walls DIAGNOSIS: Dentigerous cyst
- 13. Xray PNS Water’s view showing • Opacity seen in Rt. Maxillary, ethmoidal & Frontal sinuses DIAGNOSIS:Rt. Pansinusitis
- 15. Common radiologic abnormalities: Air-fluid levels suggest an acute process • Opacification = secretions, polyps, etc. • Thickened mucosa (check lateral maxillary wall): Suggests chronic inflammation • Maxillary sinus retention cysts – Very frequent finding – Harmless unless symptomatic • Frontal sinus mucocele – Nasofrontal duct obstruction (head injury?) – Potentially serious problem – Look for loss of scalloped edge
- 16. Nasopharynx
- 17. enlargement of the adenoids (red arrow) The white arrow points toenlarged lingual tonsils at the base of the tongue.
- 19. Neck lateral veiw 1. Cervical vertebrae • Erosion of vertebral bodies- No. • Loss of cervical Lordosis – due to prevertebral muscle spasm 2. Pre-vertebral soft tissue shadow • Should be < 2/3 of AP diameter of cervical vertebral body (c2-6mm, c6-22 mm) • If > suspect Retropharyngeal abscess • Look for FB / Air fluid level / Gas shadow 3. Air collumn in trachea 4. Hyoid bone & Laryngeal cartilage ossifications
- 22. Chronic Retropharyngeal abscess •Secondary to TB spine(Pott’s spine) •Erosion of cervical vertebra •Treatment with ATT
- 24. FB Cricopharynx with Acute retropharyngeal abscess
- 29. Foreign Body Aspiration Radiography PA & lateral views of chest & neck Inspiration & expiration Lateral decubitus views 25% have normal radiography
- 30. • Radiopaque FB easily seen with xray • Radiolucent FB (the majority) may have obliterated bronchial air column, atelectasis, mediastinal shifts, or air- trapping in the affected lung • Inspiratory hypoinflation and expiratory hyperinflation in hallmark of bronchial FB • Decubitus films – dependent lung should collapse but will remain inflated if FB
- 32. X ray neck AP view •Round radio opaque object ( Coin) •In Esophagus •Because the esophagus is an AP compressed tubular structure •A coin would occupy this position •Can be confirmed by lateral view
- 33. X ray neck Lateral view
- 34. Foreign Body Ingestion Common locations in esophagus Cricopharyngeus Aorta/left mainstem bronchus Gastroesophageal junction
- 36. Sialography Radiologic examination of the salivary glands The submandibular and parotid glands are investigated by this method The sublingual gland is usually not evaluated this way Difficulty in cannulation
- 37. Procedure 1. Obtain preliminary radiographs • Any condition that is visibe w/o contrast • Optimum technique obtained 2. 2-3 min before procedure give lemon 3. Contrast media (iohexol) injected into main duct 4. After procedure suck on lemon to clear contrast 5. 10 min after procedure take radiograph
- 41. Lateral Parotid Gland Radiograph
- 44. bronchogram Radiographic examination of the tracheobronchial tree by radiopaque iodinated compound (dianosil,iohexaol) in a low viscous suspension. rarely performed today, having been superseded by high resolution computed tomography HRCT
- 46. BARIUM SWALLOW procedure used to examine upper gastrointestinal tract,which include the pharynx, esophagus, cardia of stomach. The contrast used is barium sulfate.
- 47. CONTRAST TYPES OF CONTRAST STUDY (i) SINGLE CONTRAST STUDY (ii) DOUBLE CONTRAST STUDY
- 48. CONTRAINDICATION Suspected esophageal perforation. Tracheo-esophageal fistula If strong clincal suspicion of aspiration or TEF,then omnipaque swallow (iohexol) advised.
- 49. XRAY VIEW SOFT TISSUE NECK,CHEST – AP & LAT – SCOUT NECK-AP & LATERAL THORAX-RAO VIEW
- 50. NORMAL-AP /LAT VIEW - SCOUT
- 51. AP/LAT VIEW WITH BARIUM
- 52. RAO VIEW
- 53. TECHNIQUE PHARYNX -One mouthful contrast bolus with high density(250% w/v). -Patient is asked to swallow once and stop swallowing there after. -This is to get optimum mucosal coating. -frontal and lateral view x-ray taken.
- 54. ESOPHAGUS Single contrast -Multiple mouthful barium suspension given. -prone swallow to assess esophageal contraction. -useful in esophageal compression, displacement or disordered motility.
- 55. EFT: Lateral view: Epiglottis (red arrow). Post cricoid impression (yellow arrows). Cricopharyngeous impression (white arrow).RIGHT: AP-view: Small lateral pharyngeal pouches (arrows)
- 57. Partially obstructing cervical esophageal web. Frontal view shows a circumferential, radiolucent ring (straight white arrows) in the proximal cervical esophagus. Partial obstruction is suggested by a jet phenomenon (black arrows), with barium spurting through the ring, and by mild dilatation of the proximal cervical esophagus .
- 59. A Zenker's diverticulum is a pulsion hypopharyngeal false diverticulum with only mucosa and submucosa protruding through triangular posterior wall weak site (Killian's dehiscence) between horizontal and oblique components of cricopharyngeus muscle
- 60. CARCINOMA Preferably high viscosity with normal density barium is used. Classical finding in carcinoma –rat tail appearance.
- 61. CA ESOPHAGUSWith shouldering The stenotic segment is long giving a “" *rat-tail” appearance Barium swallow shows mild dilatation of the esophagus with irregular stenotic lesion in the lower end of the esophagus “moth eaten appearance
- 62. ACHALASIA CARDIA Bird beak appearance
- 63. 63 P-A Skull Patient seated or standing facing the Bucky. Nose and forehead touching the Bucky to get the canthomeatal line perpendicular to film.
- 65. 65 P-A Skull Film .There should be no rotation. The petrous ridges will be superimposed with the orbits. To clear the ridges, the Caldwell view can be taken.
- 66. 66 Chamberlain-Townes Patient is seated facing the tube.The chin is tucked into the chest until the canthomeatal line is perpendicular to film. A chair the allows some reclining will make this easier for the patient.
- 67. 67 Chamberlain-Townes Film The entire skull and especially the occipital region of the skull must be on the film. Structure seen include the foramen magnum, petrous ridges, IAC’s and TM Joints No rotation of skull
- 68. 68 Skull Lateral Patient seated of standing facing the Bucky. Rotate the body into an oblique position. Turn skull so the affected side is next to the Bucky. The interpupillary line must be perpendicular to film and tube. Mid sagittal plane parallel to the film.
- 70. 70 Skull Lateral Film Entire skull must be on the film. There should be no rotation of the skull, orbits and mandible ramus superimposed. The facial bones are sinuses will be dark (over exposed). Usually both lateral views are taken.