Apuntes de Radiologia Rinosinusal III Parte

8/4/2019 Apuntes de Radiologia Rinosinusal III Parte

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13/04/2012Seminarios Anatoma Clnico Radiolgica Tel.

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Apuntes de Fisiologa,

Anatoma-radiolgica-clnica

Seminarios Taller Presencial junio..2009Clnica de Asma y Alergia III.Parte

CT, MRI , Ultrasonido,

ImagenologaSinusitis Crnica otraspatologas

Lean las notas al pie de las diapositivas

NEW !
mailto:[email protected]:[email protected]:[email protected]


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RevisinDr. Juan Herrera SalazarClnica de Asma y Alergia


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Anatoma radiologicaCT Scan

Cortes axiales, Sagitales yReconstruccin coronal..

New !

Updated


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Dr. Juan Herrera Salazar


22781169,22703359, 88825513,894650223

Foro Mdico Nicaragense

Portales Mdicos

Medbook

Mi blog de Asma y Alergia
http://colmedni.ning.com/profile/DrJuanHerreraSalazarhttp://colmedni.ning.com/profile/DrJuanHerreraSalazarhttp://www.medbook.es/profile/JuanHerreraSalazarhttp://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://www.medbook.es/profile/JuanHerreraSalazarhttp://colmedni.ning.com/profile/DrJuanHerreraSalazarhttp://colmedni.ning.com/profile/DrJuanHerreraSalazarhttp://colmedni.ning.com/profile/DrJuanHerreraSalazar


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Bibliografa

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Tel. 22781169,22703359, 88825513,89465022

4

Atlas Netter II edicin.

Atlas Netter IV edicin Interactiva.

Atlas, Anatomy,Carmine de Clemente 3rd ed.. Gray s Anatomy Ed. Longman 1973.

Emedecine collection

Nasal Cavity Anatomy, Physiology, andAnomalies on CT Scan Author: Belachew Tessema,MD; Chief Editor: Arlen D Meyers, MD, MBA. Updated: Mar29, 2011
http://emedicine.medscape.com/article/875126-overviewhttp://emedicine.medscape.com/article/875126-overviewhttp://emedicine.medscape.com/article/875126-overviewhttp://emedicine.medscape.com/article/875126-overviewhttp://emedicine.medscape.com/article/875126-overview


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Bibliografa Emedecine


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Nasal Physiology Author: Sanford M Archer, MD;Chief Editor: Arlen D Meyers, MD, MBA more...

Olfactory System Anatomy Author: Amir

Vokshoor, MD; Chief Editor: Arlen D Meyers, MD,MBA more...

Nasal Aerodynamics Author: Samuel J Lin, MD;Chief Editor: Arlen D Meyers, MD, MBA more...

Nasal Reconstruction Author: Ali Sajjadian, MD,FACS; Chief Editor: Arlen D Meyers, MD,MBA more...
http://emedicine.medscape.com/article/874771-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/876456-overviewhttp://emedicine.medscape.com/article/876456-overviewhttp://emedicine.medscape.com/article/876456-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/874822-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/874771-overviewhttp://emedicine.medscape.com/article/874771-overviewhttp://emedicine.medscape.com/article/874771-overview


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Lo ms dificil es ver lo que esta delante de tus ojos W.Goethe

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Seminarios Anatoma Clnico Radiolgica

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Anatomia radiolgica


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Radiografa Craneo Rx. . Lateral


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Definicin de Sinusitis Sinusitis is an inflammation of the mucosal lining

of the paranasal sinuses. As the mucosa of thesinuses is continuous with that of the nose,rhinosinusitis is a more suitable term.[1, 2]

Sinusitis can be subdivided into acute, subacute,

and chronic disease. Acute sinusitis is defined asdisease lasting less than 1 month. Subacutedisease lasts 1-3 months, and chronic sinusitis

lasts longer than 3 months and is generallyrelated to suboptimally treated acute or subacutedisease. Acute and subacute sinusitis are treatedmedically, whereas chronic sinusitis may

require surgical intervention. 13/04/2012Seminarios Anatoma Clnico Radiolgica Tel.

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Radiografa de los Senos

Nasales

Waters(occipitomental)

Caldwell(occipitofrontal)

Vista Lateral

Vista basilar (submento-vrtice)

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Polypoid mucosal thickening in the right maxillarysinus with a mucous retention cyst in the left on aWaters view.


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CT Scan Metodo Preferido Computed tomography (CT)

scanning is the examination ofchoice in sinusitis, particularly incases of chronic sinus disease,providing excellent detail of sinusanatomy. However, CT is usually notuseful in acute sinusitis, asdiagnosis in acute cases is primarilybased on clinical findings. Goodanatomic definition is desirablebefore surgical intervention.

Coronal CT imaging is the preferredinitial procedure. Bone-window

views provide excellent resolutionand good definition of the completeostiomeatal complex and otheranatomic details that play a role insinusitis. In addition, the coronalview is best correlated with findings

from sinus surgery, with anatomyand pathology visualized in a plane

CT provides an excellent anatomic

display of soft-tissue attenuation.This depiction includes fluidlevels and polypoid masseswithin the normally air-filledcavities of the sinuses, nasalcavity, and postnasal space. Mostimportant, disease extendingbeyond the bony perimeters ofthe sinuses into the adjacent softtissue of the orbit,[7] brain, andinfratemporal fossa can beimaged.

In general, nonenhanced CT scans

suffice in cases of uncomplicatedsinusitis. Multisection CT seemsto have the potential to replaceprimary coronal CT of theparanasal sinuses without anyloss of image quality, and it may

even improve the overalldiagnostic value. However, the13/04/2012Seminarios Anatoma Clnico Radiolgica Tel.

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Tomografa Axial Computadorizada (TC) de

los senos paranasales
http://www.info-radiologie.ch/tomografia-senos-paranasales.phphttp://www.info-radiologie.ch/tomografia-senos-paranasales.phphttp://www.info-radiologie.ch/tomografia-senos-paranasales.phphttp://www.info-radiologie.ch/tomografia-senos-paranasales.php


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http://www.info-radiologie.ch/tomografia-senos-paranasales.php


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Si desean msresolucinhagn clik

info-radiologie.ch


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CT Scan Anatomia y Fisiologa

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CT scan, nasal cavity.

Normal anteriorostiomeatal complexanatomy.

The anatomy of theethmoid infundibulum

and the uncinateprocess isdemonstrated here.


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CT Scan Anatomay Fisiologa

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The uncinate process(UP) and lateral wall ofthe nasal cavity form

the ethmoidinfundibulum (EI). Theabove sinuses drain intothe EI via various ostia.The maxillary sinusostia and the frontal

sinus recess or ductdrain into the anterior-most portion of theOMC and areconsistently identifiable

on CT scan. Normalfrontal recess/duct.Frontal sinus emptiesinto the middle meatus

just lateral to the moreanterior portion of the

middle turbinate. The

COMComplejo Osteo

Meatal


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Anatoma yFisiologa

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Stammberger andMesserklinger

Drainage

Normal posteriorostiomeatal

complex. The vomerseparates the twoostia into thesphenoid sinus.

These ostia arelocated in thesphenoethmoidrecess. The vomer is

normally

Complejo OsteoMeatal Posterior

Normal


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Anatoma yFisiologa

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A normal sagittalreconstruction of the

OMC, showing thecurved edge of the

semilunar hiatus withthe inferior mucosal

edge covering the UP,can be seen in theimage below. Thefrontal recess is alsoshown.

Complejo OsteoMeatal Posterior

Normal


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Anomalas de la Cavidad Nasal

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Fusion (apparent) ofuncinate process to theethmoid floor. Note thenormal uncinate

process on the otherside. Airway flow iscompromised from thesinuses to the middlemeatus because of the

functionally occludedsemilunar hiatus.Because the maxillarysinus is patent and

aerated, this is not a


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Congenital or truefusion of the uncinateprocess to the orbitfloor. The maxillarysinus is hypoplastic andnot aerated. Theethmoid infundibulumdoes not exist or endsblindly as the recessusterminalis.

The UP tip can also

fuse directly to thelateral wall or laminapapyracea of the orbit.This anomaly producesthe same imaging

findings as inferomedialfusion.


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Bilateral

pneumatization of

the uncinate tips.

Expansion of thetips can

compromise the

ethmoid

infundibulum, thesemilunar hiatus,

or the middle

meatus.


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Anomalas de la cavidad nasal

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Concha bullosa of the

left middle turbinatewith expansion and

narrowing of theethmoid infundibulumand the middlemeatus. Note

absence of the rightuncinate process,another anatomicvariant.


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Large Haller air cellclearly narrowing the

ethmoid infundibulum.


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Overexpansion of theethmoid sinus floors

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Patrones radilogicos al CT


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Patrones radilogicos al CT

Scan

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Bilateral ethmoid

sinusitis on anMRI.


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Complejo Osteomeatal

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Mucosalthickening in

the left anteriorethmoid and

maxillarysinuses and inthe region of

theinfundibulum.This indicatesan ostiomeatal

pattern ofsinusitis


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Conca Bulosa

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Concha

bullosa ofthe rightmiddle

turbinate.


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Celdas de Haller

Paradoxical curves ofboth middle turbinatescause narrowing ofthe ostiomeatal units.

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Para los especialistas

Magnetic ResonanceImaging

Ultrasonography

Nuclear Imaging

Angiography

Sinusitis Imaging

Author: Rochita VRamanan, MBBS,MD, DNB, DMRD;Chief Editor: L GillNaul, MD

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http://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overviewhttp://emedicine.medscape.com/article/384649-overview


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CT scan Spiral CT scan

1mm cuts

Magnetic ResonanceImaging

The exclusive use of coronal CT scansfor sinus imaging could result in thefailure to diagnose nasal cavityneoplasms. In the absence of bonedestruction, an esthesioneuroblastoma or

other neoplasm may be mistaken for anasal polyp on a CT scan, whereas onMRI, the nature of this tumor is quiteapparent. Beyond anatomic variants, anysuspicious findings should be imaged by

means of MRI.

Despite advances in MRItechnology, insufficient tissue, plusthe problems of susceptibility due tothe air-containing passages, makeMRI a less effective study for nasalcavity sinusitis problems, unless ofcourse the sinusitis turns out to berelated to squamous cell carcinoma(SCCa).

To date, no new MRI contrastagents that have an affiliation for

SCCa have been released.

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Gracias !

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Gracias por la oportunidad

Desde la Clnica de Asma y Alergia

Managua , Nicaragua. Tel 22781169, 22703359,88825513

Dr. Juan Herrera Salazar

Favor ver la II Parte

Apuntes de Radiologia Rinosinusal III Parte

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