Dr.Nurlaily Idris,SpRadDr.Nurlaily Idris,SpRadDr.Sri Asriyani,SpRadDr.Sri Asriyani,SpRad

RADIOLOGY FOR DETECTED RADIOLOGY FOR DETECTED SPECIAL SENCE DISEASESSPECIAL SENCE DISEASES

Radiology ModalityRadiology Modality

- Ears Ears Plain X-Ray, CT Scan,MRI Plain X-Ray, CT Scan,MRI- Nose/sinuses Nose/sinuses Plain X-Ray, CT Plain X-Ray, CT

Scan,MRIScan,MRI- Orbita/eye Orbita/eye Plain X-Ray, USG,CT Plain X-Ray, USG,CT

Scan, MRI, AngiografiScan, MRI, Angiografi

Examination for Sinus ParanasalisExamination for Sinus Paranasalis

1. Convensional Ro:1. Convensional Ro:

- Occipitomental Occipitomental (Water’s position )(Water’s position ) sinus maxilla, frontal , sphenoid & sinus maxilla, frontal , sphenoid & os.zygomaticus, septum nasios.zygomaticus, septum nasi- Occipitofrontal ( Caldwell Position) Occipitofrontal ( Caldwell Position) Frontal, ethmoid, orbita & cavum nasiFrontal, ethmoid, orbita & cavum nasi- Lateral Lateral Frontal, maxillasphenoid, cavum Frontal, maxillasphenoid, cavum nasi & nasopharynxnasi & nasopharynx

CT – Scan/MRI CT – Scan/MRI Paranasal sinus , orbita & soft tissueParanasal sinus , orbita & soft tissue

SINUSITISSINUSITIS Acute :Acute :- Complit partial covering or partial of Complit partial covering or partial of

sinus sinus - Air fluid level Air fluid level - Thickening of mucosa of sinus ( in Thickening of mucosa of sinus ( in

allergic case allergic case scalloped )scalloped )- Polip can be found in several cases Polip can be found in several cases

Chronic :Chronic : Athropi of the sinus with polipoid Athropi of the sinus with polipoid

thickening of mucosa thickening of mucosa Sclerosis with thickening of sinus Sclerosis with thickening of sinus

bonesbones

Obstruction of ostium paranasal sinuses Obstruction of ostium paranasal sinuses caused acumulation of secret that fulfil the caused acumulation of secret that fulfil the sinus sinus

Ro :widening of sinus with covering or Ro :widening of sinus with covering or erotion of sinus wall or bulging of sinus wallerotion of sinus wall or bulging of sinus wall

MUCOCELEMUCOCELE

Complication :Complication :

- Osteomyelitis : Osteomyelitis : Covering of sinus or loss of sinus wall Covering of sinus or loss of sinus wall

borderborder- Epidural or cerebral abscess Epidural or cerebral abscess rare but rare but

seriousseriousCT – Scan is the main modality CT – Scan is the main modality

Benign:Benign:Osteoma :Osteoma : Ivory osteoma : radiopaque, yg dense, the Ivory osteoma : radiopaque, yg dense, the

border or the tumor is clear, rounded or border or the tumor is clear, rounded or lobulated, the sinus usually normal (except lobulated, the sinus usually normal (except there is obstruction of ostium)there is obstruction of ostium)

Cancellous osteoma : Radioopak (a little bit Cancellous osteoma : Radioopak (a little bit high than soft tissue)high than soft tissue)

PapillomaPapilloma : same image with polip that expand to : same image with polip that expand to cavum nasi and the sinus wall became thin.cavum nasi and the sinus wall became thin.

TUMORTUMOR

Micellaneous tumor :Micellaneous tumor : (fibroma, neurifibroma, chondroma & (fibroma, neurifibroma, chondroma &

osteochosteochCholesteatoma : same with mococeleCholesteatoma : same with mococeleMeningocele & encephaloceleMeningocele & encephalocele

Malignant : usually sinus maxillarisMalignant : usually sinus maxillarisRo :Ro :- Soft tissue mass thet fulfil the whole or a part Soft tissue mass thet fulfil the whole or a part

of sinusof sinus- Can destruct the bone and expansion to Can destruct the bone and expansion to

surroundingsurrounding

CT :- bone destruction more clearlyCT :- bone destruction more clearly -mass border more clearly-mass border more clearly -the expansion of tumor more clearly -the expansion of tumor more clearly -can detected the necrotic area and -can detected the necrotic area and abcess abcess

a. b.

c.

a. Normal CT Scan,coronal scan b. Normal CT Scan , axia scanlc. CT Scan axial, obliterasi fossa

Rossenmuller extra & parafaring area dextra

EARSEARS

Plain X-Ray ( Conventional Ro )Plain X-Ray ( Conventional Ro ) - Lateral oblik ( mastoid, meatus ext, middle ear)- Lateral oblik ( mastoid, meatus ext, middle ear) - PA supraorbital & cantomeatal (Towne Vincent)- PA supraorbital & cantomeatal (Towne Vincent) ( meatus acus.int,cochlea,mastoid & anthrum( meatus acus.int,cochlea,mastoid & anthrum - PA Oblik ( Stenver )- PA Oblik ( Stenver ) ( mastoid,os. petrous, meatus .acusticus .int, ( mastoid,os. petrous, meatus .acusticus .int, canalsemicir)canalsemicir)CT – Scan CT – Scan M R IM R I

Acute otitis media & mastoiditis :Acute otitis media & mastoiditis :- Lose of tuba eustachi and meatus Lose of tuba eustachi and meatus

acusticus media radiolucensy acusticus media radiolucensy - anthrum mastoid more radiopaque anthrum mastoid more radiopaque

and covering/ blurred of outter and covering/ blurred of outter border of mastoidborder of mastoid

Chronic Mastoiditis :Chronic Mastoiditis :- Sclerosis of air cells mastoidSclerosis of air cells mastoid- Complication of abscess & sequester with Complication of abscess & sequester with

sclerotic of mastoid ( difficult to diff with sclerotic of mastoid ( difficult to diff with cholesteatoma ) cholesteatoma ) if Abscess the border if Abscess the border more clearlymore clearly

- Can caused extradural& intra cerebral Can caused extradural& intra cerebral sepsissepsis

- Can caused serious complication Can caused serious complication cholesteatomacholesteatoma

Radiology modality :Radiology modality : Convensional Rö : Convensional Rö : - occipitofrontal projection- occipitofrontal projection - lateral projection- lateral projection - oblique, 35- oblique, 3500

CT-Scan CT-Scan USGUSG M R IM R I AngiographyAngiography

ORBITSORBITS

Conventional X-Ray :Conventional X-Ray :- Difficult to detect abnormality of Difficult to detect abnormality of

intra & extra ocular except if there intra & extra ocular except if there are radiopaque density, can detect are radiopaque density, can detect fracturefracture

- CT-Scan CT-Scan main modality main modality

CalsificationCalsification

Rare on soft tisue, but if found Rare on soft tisue, but if found significant sign and patognomonis for significant sign and patognomonis for some conditions assome conditions as : :

- CataracCatarac- Retrolental fibroplasia Retrolental fibroplasia - RetinoblastomaRetinoblastoma

- Cataract Cataract sirculer calsification in lens, sirculer calsification in lens, ± 7 mm (PA)± 7 mm (PA)

- Retrolental fibroplasia Retrolental fibroplasia little little calsification intravitreal, in advance calsification intravitreal, in advance condition can found with lenticulercondition can found with lenticuler

- Retinoblastoma Retinoblastoma spotted calsification spotted calsification that union, and found bilateralthat union, and found bilateral

The others calsification can also caused by:The others calsification can also caused by:- Angioma - HematomaAngioma - Hematoma- Aneurisma - AVMAneurisma - AVM- Meningioma - Kavernous hemangiomaMeningioma - Kavernous hemangioma- Glioma Glioma

EROSION & DEFECT OF ORBITA BONE :EROSION & DEFECT OF ORBITA BONE :

- Dermoid & Epidermoid : Usually in Dermoid & Epidermoid : Usually in superolateral orbita with sclerotic superolateral orbita with sclerotic borderborder

- Glandula lacrimal tumorGlandula lacrimal tumor- Ca.Nasofaring & sinus paranasalisCa.Nasofaring & sinus paranasalis

INFECTIONINFECTION

CT : coronal/axial CT : coronal/axial - Thickening of extra okuler muscle- Thickening of extra okuler muscle - hipertrofi orbital fat- hipertrofi orbital fat - edema interstitial of konjungtiva- edema interstitial of konjungtiva - degenerasi ekstraokuler muscles- degenerasi ekstraokuler muscles

CelulitisCelulitis

Usually caused by sinusitis & traumaUsually caused by sinusitis & trauma→ → osteomielitis, septik tromboplebitis, osteomielitis, septik tromboplebitis,

meningitis, dll.meningitis, dll.Plain X –Ray : opaque on sinus, destruksi of Plain X –Ray : opaque on sinus, destruksi of

bones caused by osteomielitis.bones caused by osteomielitis.

CT-Scan :CT-Scan :- Can be found abses formation ( mass with Can be found abses formation ( mass with

unclear border with enhancement)unclear border with enhancement)- Udema preseptal soft tissueUdema preseptal soft tissue- Udema outline retrobulber structurUdema outline retrobulber structur- Opague pd sinus paranasalis Opague pd sinus paranasalis

(radang/mass)(radang/mass)M R I M R I same with CT Scan, but MRI can same with CT Scan, but MRI can

make more different positions & conditionsmake more different positions & conditions