Intranasal disease: Is radiology discriminatory

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Intranasal disease Is radiology discriminatory

• Murcia
• PhD Programme
• 1

Prof Martin Sullivan
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Aim

• to define radiographic appearance of intranasal
  disease
• Intended Learning Outcomes
• be able to assess the quality of the radiograph
• through a structured interpretation
• distinguish intranasal disease from normality
• recognise the limitations of plain radiography

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Common Diseases- Dog

• neoplasia
• chronic rhinitis
• aspergillosis
• foreign body
• nasal discharge
• often non-specific

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Nasal Radiography- Views
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Radiography
Note 1 in certain circumstances DV skull is
useful to evaluate cribriform plate 2 if
horizontal beam possible CdR frontal sinus is
easier to take than RCd
CdR Frontal sinus
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Lateral view

• superimposition
• nasal bones
• s
• osteomyelitis

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Dorso-Ventral Intra-Oral view

• best view
• screens in plastic bag
• screen contact

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VDIO- view

• use cassette
• dvio screen damage
• gag
• tongue
• projection effect
• exposure latitude
• poor detail

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VDIO- view

• gag
• tongue
• projection effect
• exposure latitude
• poor detail

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Frontal Sinuses

• RCd
• tilting/balance
• safety
• anaesthesia
• endotracheal tube

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Rostro-Caudal view

• skylines frontal sinuses
• extra-nasal neoplasia
• aspergillosis

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Caudo-Rostral view

• CdR
• easier to position
• good image
• horizontal beam
• safety
• radiation

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RCd Frontal Sinuses
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Assessing the DVIO view

• vomer/septum
• R L
• rostral/caudal
• cranio-medial root of PM4
• maxilloturbinates/ventral concha
• ethmoturbinates

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Assessing the DVIO view

• rostral
• ventral concha
• maxilloturbinates

• caudal
• ethmoturbinates

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Terms implications

• turbinate destruction
• neoplasia
• aspergillosis
• turbinate masking
• chronic rhinitis
• normal turbinate pattern
• foreign body

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Interpretation

• Turbinate destruction masking

aspergillosis
neoplasia
chronic rhinitis

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Change in opacity

• homogenous soft tissue opacity
• neoplasia
• increased radiolucency
• aspergillosis

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Change in opacity

• neoplasia

• aspergillosis

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Neoplasia

• destruction
• soft tissue

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Neoplasia

• nasal bone case

• cribriform plate

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DV Skull
tumour
Note in certain circumstances DV skull is useful
to evaluate the cribriform plate. But the
rostral portion is masked by the mandibles
asp
?
20oVDIO
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Aspergillosis (destructive rhinitis)

• destruction
• radiolucency

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Aspergillosis

• difficult

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Aspergillosis

• difficult

• granulomas

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Aspergillosis- sinuses

• opacification
• thickening
• motheaten

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Chronic Rhinitis

• masking

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Chronic Rhinitis

• masking
• old dog atrophy
• diagnosis often by exclusion

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Feline Nasal DiseaseHow do I Know What I am
Looking at ?
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Cats very difficult

• perspective on diagnoses
• options for image acquisition
• interpretative route

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Cat versus Dog

• chronic rhinitis
• neoplasia
• epithelial
• lymphoid
• odds sods

• aspergillosis
• foreign body
• chronic rhinitis
• neoplasia
• odds sods

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Clinical

• do not overlook
• the obvious

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Lateral

• bones
• superimposition

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DV Skull

• superimposition

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RCd Frontal Sinuses

• skylines
• positioning

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RCd Frontal Sinuses

• skylines
• positioning

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CdR Frontal Sinuses - Dog
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CdR Frontal Sinuses

• 15o
• horizontal

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CdR Frontal Sinuses
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DVIO

• detail
• restricted

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DVIO

• detail
• non-screen film

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DVIO

• detail
• screen damage

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VDIO

• coverage
• positioning

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VDIO

• coverage
• positioning

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Effect of Exposure
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Interpretation

• S septum
• normal

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Interpretation
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Some are Easy - FB pellet
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Classic Neoplasia
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Classic Rhinitis
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Aspergillosis !
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Chronic Rhinitis - Mixed
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Chronic Rhinitis - Mixed
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Chronic Rhinitis - Subtle
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Progression - 1yr on
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Chronic Rhinitis- Mmmm
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Chronic Rhinitis - Really
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Neoplasia
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Neoplasia
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Neoplasia vs Rhinitis
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Cat

• tumour
• lymphosarcoma
• adenocarcinoma
• rhinitis
• asp rarely reported

rhinitis tumour
note in the cat 20oVDIO is as good as DVIO
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Diagnosis ?

• 5yr old Siamese
• history of Cat Flu
• 6 months later
• suggests rhinitis
• BUT

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Biopsy is Essential in the Cat
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Can the owner be believedof course not

• my cat has a nasal FB
• it is a nylon mesh

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Believe the owner

• my cat has a nasal FB
• it is a nylon mesh

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Believe the owner

• my cat has a nasal FB
• it is a nylon mesh
• Oops !!!