Radiology of The Ear

1

• Radiology of The Ear

MRI
Plain X Ray
CT Scan
Demonstrates VIII nerve Brain Great vessels
Of limited value Demonstrates Mastoid air cells

• Accurately demonstrates
• External ear
• Middle ear
• Surrounding structures

2

• lateral Oblique (Mastoid)view

• Locate the Temporo-mandibular joint the external
  auditory canal (EAC) which is a complete circle
• The mastoid air cells are behind and above the EAC

3

• lateral Oblique (Mastoid)

TMJ
External auditory canal
Pneumatised mastoid air spaces separated by bony
partitions
4

• The mastoid cells (white arrow) are obscured, and
  not air-containing, due to chronic otitis media.

External auditory canal
TMJ
5

• Schüller view Well-developed normally
  pneumatized mastoid air cells can be observed in
  the picture on the left side (double arrow).
• In the picture on the right side, the mastoid
  cells (arrow) are obscured, and not
  air-containing, due to chronic otitis media.

TMJ
Sinodural angle
EAC
6
TMJ
External auditory canal

• There is a clean cavity behind and above the
  external auditiry canal not surrounded by
  sclerosis
• Diagnosis surgical cavity of mastoidectomy

7
Petrous bone

• Axial CT scan, the destructed apex of the petrous
  bone can be observed (white arrow), which is
  caused by ? cholesteatoma.

8

• Axia CT scans
• The mastoid cells on the right side (green arrow)
  are totally obscured, which proves mastoiditis.
• On the left side (blue arrow), an intact status
  can be seen.

9

• Axial CT scans
• Transverse temporal bone fracture (arrows).

10

• imaging of the nose

• MRI

Plain X Ray
CT Scan

• Accurately demonstrates
• Nose
• Paranasal sinuses
• Surrounding
• structures

Mainly for Surrounding soft tissue structures
limited value Screening of sinuses Medico-legal
IN NASAL BONE FRACTURE
11

• Occipito-mental projection

• Patient facing the film
• Radiologic base line tilted 450
• Beam horizontal , directed to external occipital
  protuberance

12
Frontal sinus
orbit

• septum

Maxillary sinus
Maxillary sinus
Sphenoid sinus
13
NB

• Radiologic Examination of sinuses should be
• In erect position
• Sphenoid is seen in occipitomental view with open
  mouth

14

• Frontal Sinus
• Ethmoid Sinus
• Maxillary Sinus
• Soft Palate
• Nasopharynx
• Sphenoid Sinus
• Sella Turcica
• Clinoid Process

15

• Occipito-mental view of the sinuses showing
  partial opacification of the right maxillary
  sinus, with an air-fluid level

• Acute Sinusitis

16

• An air-fluid level

• Acute Sinusitis

17
NASAL FRACTURE

• Loss of continuity of nasal bone with
  displacement of distal fragment

18

• CT SCAN

• Axial view
• Coronal view

19
Coronal CT scanNormal findings

• The sinuses normally contain air which is seen in
  black color
• The frontal sinus
• Above the orbit
• Seen in the anterior cuts
• May be absent

• ORBIT

• ORBIT

20

• Ethmoid sinuses
• 15 to 20 air cells in each side
• Medial to Lamina paparycea
• Maxillary sinus
• - Below the orbit

• ORBIT

Ethmoid
Maxillary
Maxillary
21

• Sphenoid Sinus
• Divided by a septum into right and left sinuses
• The floor of the sinus is the roof of the
  nasopharynx

Sphenoid
22
Orbit
Bulla Ethmoidalis
Middle Turbinate
Maxillary Sinus
Middle Meatus
Uncinate process
Inferior Turbinate
Inferior Meatus
23
PATHOLOGICAL FINDINGS
24

• CORONAL CT
• SHOWING
• THICKENING OF
• THE FRONTAL
• SINUS MUCOSA

25

• Osteoma. A left frontal osteoma ( arrow) is
  visible anteriorly in this coronal CT scan. Note
  its increased density, characteristic of the
  lesion.

26

• Coronal CT scan showing normal ostiomeatal
  complex. Patent ostia are visible on both sides,
  and sinuses are well ventilated.

27

• Coronal CT scan
• Total ethmoid opacity ( ethmoidal polypi)
• Fluid level in the left maxillary sinus
• Diagnosis bilateral ethmoid sinusitis Left
  maxillary sinusitis

28

• Coronal CT scan
• Blocked osteomeatal complex
• Opacity of right ethmoidal air cells
• Fluid level in the left maxillary sinus
• Thickened mucosa of right maxillary sinus
• Diagnosis bilateral Maxillary sinusitis, right
  ethmoid sinusitis

29

• Coronal CT scan
• Blocked ostiomeatal complex

Maxillary sinus
Maxillary sinus
30

• A coronal CT scan
• Moderate bilateral maxillary sinus mucosal
  thickening with blockage of both ostiomeatal
  complexes
• Chronic sinusitis

31

• A coronal CT scan.
• Complete opacification of the right maxillary
  sinus
• Mucosal thickening of the left maxillary sinus
• Chronic sinusitis

32

• Coronal CT scan
• Concha bullosa i.e pneumatized middle turbinate
• A deviated nasal septum.

33

• Concha bullosa i.e pneumatized middle turbinate
  ( red arrow).

orbit
orbit
Maxillary sinus
34

• Pardoxical middle turbinates.

35

• Coronal CT scan
• Bilateral total opacity of ethmoid sinuses
• Bilateral Ethmoidal polypi

36

• Coronal CT scan showing right maxillary sinus
  opacification.  Also, note the septal deviation
  to the right and the hypertrophy of the left
  inferior turbinate (yellow arrow)

37

• Coronal CT scan of the sinuses showing bilateral
  maxillary sinusitis. 
• The opacification is more prominent on the left
  side (arrow).

38

• Oroantral fistula
• Enumerate 3 causes starting with the most common
  cause

39

• Comment

40

• Complete right maxillary sinus opacity
• Opacity and Widening of the right osteomeatal
  complex
• Soft tissue opacity in the nasopharynx

41
Inverted Papilloma

• Soft tissue mass in the nasal cavity and left
  maxillary and ethmoidal sinuses
• The left middle meatus and medial wall of the
  left maxillary sinus are absent.
• There is mucosal thickening of the right
  maxillary sinus

• Differential Diagnosis
• Inverted papilloma
• Antrochoanal polyp
• Squamous cell
• carcinoma

42

• Coronal CT scan
• Bilateral sphenoidal sinus opacity
• Diagnosis Bilateral Sphenoid sinusitis

43

• Axial CT scan

44
There is soft-tissue thickening over the
expanded Right Frontal Sinus
??
left Frontal sinuses are partially opacified
by mucoperiosteal thickening
Axial CT scan
expansion of the Right Frontal sinus.
45

• Hyperdense sinus secretions. This axial CT
• scan shows hyperdense secretions in the left
• maxillary antrum. fungal sinusitis.

46

• Sinonasal polyposis.
• Note the polypoid changes with opacification and
• expansion of the right Nasal cavity, right
  maxillary
• sinusitis coexists.

47
MRI

• Coronal MRI scan showing opacification of the
  left maxillary and ethmoid sinuses

48

• Axial MRI scan showing opacification of the left
  maxillary sinus

49

• imaging of the pharynx

50
Barium swallow
Plain X Ray
CT Scan

• Accurately demonstrates
• Pharynx
• Surrounding srtucture
• with LN

The lumen
limited value demonstrates Lumen of pharynx
51

• Lateral soft tissue X ray of the head and neck
• Soft tissue shadow arising from the roof and
  posterior wall of the nasopharynx indenting the
  nasopharyngeal airway (green arrow)
• Suggesting adenoid
• ( blue arrow)

52
Lateral view of the Neck

• Look for
• The vertebral column ( for any destruction e.g in
  Potts disease)
• The pre-vertebral space (3/4 the width of the
  body of the vertebra)
• The airway

53

• Widening of the radiological pre-vertebral space
• Acute Retropharyngeal abscess

54
wide prevertebral space (blue arrow) pushing the
airway anteriorly (yellow arrow) in the lower
half of the neck Hypopharyngeal mass
55
Retropharyngeal abscess

• Notice the markedly thickened prevertebral soft
  tissue space (between arrows)
• Notice the destruction of 5th 6th cervical
  vertebra
• Potts Disease

56
Potts Disease
57

• Safety pin in hypopharynx

58

• Coins are probably the most commonly ingested
  foreign bodies in children

59

• AP and lateral plain films showing a metallic
  foreign body in the upper esophagus.  Most
  foreign bodies are found at the level of the
  cricopharyngeus muscle

60

• Chest X-Ray showing the metallic hook of the
  partial denture (right). The rest of the plate is
  radiolucent.

61

• Coin shaped shadow is seen in the lower neck and
  above the level of the clavicle. Swallowed Coin
  is seen by esophagoscopy

62

• Lateral radiograph of the neck reveals metalic
  foreign body in the hypopharynx

63

• A pouch in the lower neck filled with
  radio-opaque dye

Pharyngeal pouch
64

• Imaging of the esophagus

65
Barium swallow
Plain X Ray
CT Scan
demonstrates The lumen
Radio-opaque foreign body

• Accurately demonstrates
• The esophagus
• Surrounding srtucture
• with LN

66
Barium Swallow

• Look for
• Stricture
• length
• regular or irregular
• beginning,( e.g conical , shouldering
• Site ( at or high above the cardia)
• Pre-stenotic dilatation( small, moderate or
  huge dilatation)

67
Achalasia

• The stricture is
• 1-smooth
• 2- conical
• 3- at the cardia
• Pre-stenotic
• dilatation is huge

68
Achalasia

• This 63 year old man presented with a long
  history of dysphagia, regurgitation of undigested
  food and a nocturnal cough.
• Barium swallow shows marked dilatation of the
  esophagus above the smooth tapering lower end
•  
• Endoscopy showed a large volume of food residue
  within the oesophagus.  The mucosa appeared
  normal. 

69
Carcinoma of oesphagusThe stricture
is-irregular-short-shoulderingprestenotic
dilatation is moderate
70

• 71-year-old man with distal esophageal stricture
  shows malignant-appearing stricture (arrows) in
  distal esophagus.
• Narrowed segment has markedly irregular contour
  shouldering

71
Post corrosive stenosis

• The stricture is
• Long segment
• Conical beginning
• High above the cardia
• The pre-stenotic
• dilatation is small

72

• Trachea

73

• Child with croup. Note the pencil sign of the
  proximal trachea evident on this anteroposterior
  film

74

• The majority of children who aspirate a foreign
  body are in the pre-school age group (1 to 5
  years).
• The most common foreign bodies are nuts but any
  other objects about the size of a peanut can be
  inhaled (eg beads, plastic toys).
• Many children will not have a history of a
  choking episode, however, a history of acute
  choking, cough, breathlessness or wheeze may all
  indicate inhalation of a foreign body.

75

• Chest radiograph of a child with no abnormality
  identified

76

• PA chest,
• Diagnosis Right lung collapse
• ? FB in the right main bronchus

77

• Complete right lung atelectasis

78

• Same child after extraction of the foreign body
  showing re-expansion of the left lung

• Foreign body
• Collapsed left lung

79

• Expiratory chest radiograph. Air trapping in the
  left lung prevents air being expelled during
  expiration so the left lung remains more lucent
  (darker) and the mediastinum shifts to the right
  as the right lung decreases in volume normally.

80

• A tooth (molar) was dislodged during intubation.
  The patient developed a lobar pneumonia from the
  tooth,

81

• Aspirated foreign body (backing to an earring)
  lodged in the right main stem bronchus

82

• Clinical presentationChild admitted with
  breathing problems after playing with plastic toy
  and a small piece is now missing.
• The right lung volume is increased and has
  herniated across the mid-line. The left lung is
  compressed by the displaced heart and
  mediastinum.

83

• This patient was able to speak, in spite of the
  fact that she had an uncapped tracheostomy tube.
   A suction catheter could not be introduced more
  than a few inches before meeting resistance.  
• The picture above is a sagittal reformatting of a
  neck CT scan that shows the tracheotomy cannula
  in a false tract, outside the trachea.  
• The axial CT scan picture below shows the same
  tracheostomy cannula anterior to the trachea.