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M-1 RADIOLOGY Head and Neck. OBJECTIVES. Skull anatomy Orbit anatomy Sinus anatomy Vascular anatomy Neck anatomy Clinical cases. CASE HISTORIES: Facial pain Trauma to orbit Epistaxsis Allergic reaction Bruit heard in neck Neck mass inferiorly Hoarseness Blurred vision.

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Presentation Transcript
slide1

M-1

RADIOLOGY

Head and Neck

objectives
OBJECTIVES
  • Skull anatomy
  • Orbit anatomy
  • Sinus anatomy
  • Vascular anatomy
  • Neck anatomy
  • Clinical cases
slide3

CASE HISTORIES:

  • Facial pain
  • Trauma to orbit
  • Epistaxsis
  • Allergic reaction
  • Bruit heard in neck
  • Neck mass inferiorly
  • Hoarseness
  • Blurred vision
slide4

SINUSES

PA view

Nasal Septum

Frontal Sinus

Maxillary Sinus

Ethmoid Sinus

Inferior Turbinate

Odontoid process

Superior orbital fissure

2

7

4

3

1

5

6

slide5

AP WATERS VIEW

SINUSES

1. Frontal sinus

2. Ethmoid Sinus

3. Nasal Septum (bony)

4. Zygomatical-Frontal Suture

5. Maxillary Sinus

6. Zygoma

7. Zygomatic Arch

8. Mandible

9. Inferior orbital margin

10. Left orbit

1

10

2

4

5

3

6

9

7

8

This view is angled to project the maxillary sinuses free of the petrous ridge.

slide6

1. Frontal Sinus

2. Maxillary Sinus

3. Ethmoid Sinus

4. Spenoid Sinus

5. Sella Turcica

6. Occipital Bone

7. Mastoid Air Cells

8. Floor of posterior fossa

9. Anterior arch of C-1

10. Mandible

11.Coronal Suture

11

1

3

5

7

2

4

6

9

8

10

LATERAL SINUS & SKULL

slide7

SKULL

Townes view

1. Parietal bone

2. Lambdoid suture

3. Foramen magnum

4. Petrous temporal bone

5. Mandible

6. Mastoid air cells

1

1

2

3

4

6

5

slide8

1. Lat. & Med. ptyergoid plate

  • 2. Ethmoid Sinus
  • 3. Odontoid Process
  • 4. Sphenoid Sinus
  • 5. Foramen ovale
  • 6. Maxillary Sinus
  • 7. Mastoid air cells
  • 8. Ant arch of C-1
  • 9. Margin of foramen magnum
  • 10. Ext. auditory canal

6

2

1

5

4

10

8

3

7

9

BASE OF SKULL

slide9

CAROTID CANAL

JUGULAR FORAMEN

CT SKULL BASE

slide10

MANDIBULAR

CONDYLE

MASTOID AIR CELLS

CT SKULL BASE

slide11

ZYGOMATIC ARCH

EXTERNAL

AUDITORY CANAL

CT SKULL BASE

slide12

FORAMEN OVALE

FORAMEN SPINOSUM

CT SKULL BASE

slide13

MALLEUS

INCUS

MIDDLE EAR OSSICLES

CAROTID CANAL

CT SKULL BASE

slide14

CAROTID CANAL

OSSICLES

MALLEUS

INCUS

IAC

INTERNAL AUDITORY CANAL

CT SKULL BASE

slide15

3

  • LATERAL NECK
  • Hard pallate
  • Soft pallate
  • Nasopharynx
  • Oropharynx

1

2

4

slide16

AIRWAY

  • Calcified tracheal cartilage rings
  • Hyoid bone
  • Epiglottis
  • Thyroid cartilage
  • Cricoid cartilage

3

2

5

4

1

LATERAL VIEW OF NECK

slide17

SWALLOWING STUDY

1

2

4

3

Note hyoid bone moves anteriorly and superiorly with swallowing.

slide18

ARTERIOGRAM

  • Internal Carotid Artery
  • Intracranial Carotid
  • Maxillary Artery
  • Occipital Artery
  • External Carotid Artery
  • Common Carotid Artery
  • Facial Artery

2

3

4

7

1

5

6

slide20

CT- SINUS

AXIAL VIEW

1. Frontal Sinus

1

Scans start superiorly and are shown going inferiorly

slide21

CT- SINUS

AXIAL VIEW

1. Ethmoid Sinus

2. Sphenoid Sinus

3. Carotid canal

1

2

3

slide22

CT- SINUS

AXIAL VIEW

  • Maxillary Sinus
  • Med. & Lat. Pterygoid plate
  • Nasopharynx
  • Nasal septum
  • Inferior turbinate

1

4

5

2

3

slide23

CT- SINUS

AXIAL VIEW

1

  • Maxillary Sinus
  • Hard Palate
  • Mandible
  • Masseter muscle

2

4

4

3

3

slide24

CT- SINUS

Coronal sections extending from anterior to posterior

2

  • Fronto-nasal suture
  • Frontal sinus
  • Nasal bones

1

3

slide25

CT- SINUS

CORONAL VIEW

1

1. Ethmoid sinus

2. Inferior turbinate

3. Middle turbinate

3

2

slide26

CT- SINUS

CORONAL VIEW

  • Maxillary sinus
  • Nasal Septum

1

2

slide27

CT- SINUS

CORONAL VIEW

1

  • Sphenoid sinus
  • Hard Palatte

2

slide28

CT ORBIT

AXIAL SCAN

  • Retrorbital fat
  • Medial rectus
  • Lens
  • Lateral rectus
  • Optic nerve

2

4

1

3

5

slide29

LT

MAXILLARY SINUSES

ZYGOMA

SCAN LEVEL

ZYGOMA

SPHENOID

SINUS

Sections from the skull base extending inferiorly through the neck.

slide30

MANDIBULAR

CONDYLE

LT

MAXILLA

SCAN LEVEL

EXTERNAL

AUDITORY

MEATUS

NASOPHARNYX

MASTOIDS

slide31

MANDIBLE

LT

MASSETER

MUSCLE

MASSETER

MUSCLE

SCAN LEVEL

PTERYGOID

MUSCLES

PAROTID

GLAND

slide32

LT

SUBMANDIBULAR

GLAND

SCAN LEVEL

EPIGLOTTIS

STERNOCLEIOMASTOID

MUSCLE

SUBCUTANEOUS

FAT

slide33

LT

HYOID BONE

SCAN LEVEL

VALLECULA

PRYIFORM SINUS

JUGULAR

VEIN

JUGULAR

VEIN

COMMON CAROTID

ARTERIES

slide34

LT

STERNOCLEIDOMASTOID

MUSCLE

SCAN LEVEL

THYROID CARTILAGE

VOCAL CORD

slide35

LT

THYROID CARTILAGE

SCAN LEVEL

COMMON CAROTID

ARTERY

CRICOID

CARTILAGE

JUGULAR

VEIN

slide36

LT

SCAN LEVEL

THYROID

GLAND

CLAVICLE

CLAVICLE

FAT

FAT

ESOPHAGUS

TRACHEA

slide37

CASE HISTORIES:

  • Facial pain
  • Trauma to orbit
  • Epistaxsis
  • Allergic reaction
  • Bruit heard in neck
  • Neck mass inferiorly
  • Hoarseness
  • Blurred vision
slide38

FACIAL PAIN

AND

NASAL CONGESTION

slide40

CT SINUS

MAXILLARY

ETHMOID

AXIAL SCAN

Opacified maxillary and ethmoid sinuses

slide41

CT SINUS

CORONAL

SCAN

Opacified left maxillary sinus. The patient has had surgery on right maxillary sinus to create a nasal antral window to improve drainage.

slide42

CT SINUS

AXIAL SCAN

normal

Note the destroyed posterior wall of the left frontal sinus due to bacterial invasion.

slide44

ORBITAL FLOOR FRACTURE

Arrow points to bone fragment displaced into orbit.

slide45

CT FACIAL

CORONAL SCAN

CT scans redemonstrate fracture and edema at site.

slide46
TRIPOD FRACTURE
  • Zygomatic-frontal suture
  • Zygomatic arch
  • Maxillary sinus wall

Trauma to the maxilla can fracture at the 3 sites creating a Tripod fracture.

slide47

ZYGOMATIC

FRACTURE

slide49

Here external carotid arteriogram shows abnormal vessels in the nasal cavity due to vascular tumor.

slide50

Vascular Tumor

Normal

Tumor seen is rare but typical for angiofibroma

slide51

EMBOLIZATION

Radiologist has directed a coil through the catheter to occude vessels that were bleeding so controlled surgery could be done.

slide53

Note the thickened soft tissue at the epiglottis at the arrow. This can occlude the airway due to edema from reaction.

slide55

Normal

Abnormal

slide56

Normal

Ultrasound and arteriogram show high grade narrowing of internal carotid artery due to atherosclerosis.

rt middle cerebral ischemic infarction
RT. MIDDLE CEREBRAL ISCHEMIC INFARCTION

R

The CT scan shows ischemic stroke has occurred due to embolus of atheroma from stenosis occluding the middle cerebral artery in the brain . The lower density to the brain is due to edema from ischemia.

slide59

THYROID

SCAN

Nuclear Medicine

Chest x-ray showing superior Mediastinal mass with displacement of the trachea to the right. Considerations would include enlarged thyroid tissue or tortuous vessels. Nuclear Medicine I123 thyroid scan shows lobular mass extending inferiorly from the left lobe of the thyroid indicating a thyroid goiter accounting for displacement on chest x-ray.

slide60

THYROID SCAN

Nuclear Medicine

Compare the abnormal thyroid scan with the symmetric normal exam above.

slide61

CT scan shows left thyroid mass at the level of the clavicles displacing the trachea to the right.

slide64

ASPIRATION

NORMAL

A small amount of barium has extending anteriorly with aspiration into the airway.

slide65

Here two patients with mass in their chest have involvement of the

recurrent laryngeal nerve causing hoarseness due to vocal cord paralysis.

slide66

This patient’s problem is due to a lung malignancy which invades the mediastinum and involves

the recurrent nerve.

slide68
Here the mass is due to a large thoracic aneurysm of the aorta with mass effect on the recurrent laryngeal nerve.
slide70

VISUAL FIELD DEFECT

BLURRED VISION

slide71

Normal skull

Normal Sella

slide72

Normal

Sella Mass

Compare the normal with the enlarged pituitary adenoma. The mass impinges on the optic chiasm to create the visual disturbance.