Ent radiology

RADIOLOGYENT

Water's - best for maxillary sinus(Ethmoids and frontals too far from film)

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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.

Caldwellbest for ethmoids and frontal sinus

(Temporal bones overlie maxillary)

Xray PNS Water’s view showing

• Opacity inB/L maxillary sinuses

• Diagnosis:– B/L Maxillary sinusitis


• Opacity in Right maxillary sinus

• Diagnosis:– Rt. Maxillary sinusitis


• Radiodense lesion / opacity in Left maxillary sinus & Left nasal cavity

• Diagnosis:– Lt. AntroChoanal Polyp

Xray of PNS – Water’s view showing Rt. Antral Polyp • Opacity seen in Rt.

Maxillary sinus• Convexity

upwards


• Opacity seen in Rt. Maxillary sinus

• Tooth on the medial wall

• Thinned out Sinus walls

DIAGNOSIS:

Dentigerous cyst


• Opacity seen in Rt. Maxillary, ethmoidal& Frontal sinuses

DIAGNOSIS:Rt.Pansinusitis

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

Nasopharynx

enlargement of the adenoids (red arrow) The white arrow points toenlarged lingual tonsils at the base of the tongue.

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 trachea4. Hyoid bone & Laryngeal cartilage ossifications

Chronic Retropharyngeal abscess

•Secondary to TB spine(Pott’s spine)

•Erosion of cervical vertebra

•Treatment with ATT

FB Cricopharynx with Acute retropharyngeal abscess

Foreign Body Aspiration

Radiography

PA & lateral views of chest & neckInspiration & expirationLateral decubitus views

25% have normal radiography

• 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

Foreign Body Aspiration

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

X ray neck Lateral view

Foreign Body Ingestion

Common locations in esophagus

CricopharyngeusAorta/left mainstem bronchusGastroesophageal junction

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

Procedure1. Obtain preliminary radiographs

• Any condition that is visibe w/o contrast• Optimum technique obtained

2. 2-3 min before procedure give lemon3. Contrast media (iohexol) injected into main duct4. After procedure suck on lemon to clear contrast5. 10 min after procedure take radiograph

Parotid Radiographs Set-Up

Parotid Radiographs

Lateral Parotid Gland Radiograph

Lateral Submandibular Set-Up

Lateral Submandibular Glands

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

BARIUM SWALLOW

procedure used to examine upper gastrointestinal tract,which include the pharynx, esophagus, cardia of stomach.

The contrast used is barium sulfate.

CONTRAST

TYPES OF CONTRAST STUDY (i) SINGLE CONTRAST STUDY

(ii) DOUBLE CONTRAST STUDY

CONTRAINDICATION

Suspected esophageal perforation.

Tracheo-esophageal fistula

If strong clincal suspicion of aspiration or TEF,then omnipaque swallow (iohexol) advised.

XRAY VIEW

SOFT TISSUE NECK,CHEST – AP & LAT – SCOUT

NECK-AP & LATERAL

THORAX-RAO VIEW

NORMAL-AP /LAT VIEW - SCOUT

AP/LAT VIEW WITH BARIUM

RAO VIEW

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.

ESOPHAGUSSingle contrast -Multiple mouthful barium suspension given.-prone swallow to assess esophageal contraction. -useful in esophageal compression, displacement or disordered motility.

EFT: Lateral view: Epiglottis (red arrow). Post cricoid impression (yellow arrows). Cricopharyngeous impression (white arrow).RIGHT: AP-view: Small lateral pharyngeal pouches (arrows)

PHARYNGEAL WEB

.

P

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 .

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

CARCINOMA

Preferably high viscosity with normal density barium is used.

Classical finding in carcinoma –rat tail appearance.

CA ESOPHAGUSWith shouldering The stenotic segment is long giving a “" *rat-tail” appearanceBarium swallow shows mild dilatation of the esophagus with irregular stenotic lesion in the lower end of the esophagus “moth eaten appearance

ACHALASIA CARDIA

Bird beak appearance

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P-A Skull

Patient seated or standing facing the Bucky. Nose and forehead touching the Bucky to get the canthomeatal line perpendicular to film.

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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.

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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.

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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 JointsNo rotation of skull

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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.

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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.

Education

Ent radiology