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Undergraduate Ent Radiology: Dr. Davis Thomas Pulimoottil

This document provides guidance on reporting key details in radiology reports. It discusses how to describe 7 key pieces of information for various types of x-rays, including whether they are plain or contrast images, the body part and view. For x-rays of the mastoids, it outlines the normal structures seen on Law's view and how to differentiate pathologies. For sinus x-rays, it discusses evaluating haziness and common findings. It also provides details on evaluating nasopharyngeal, neck, and chest x-rays, including describing the appearance and levels of foreign bodies.

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Asif Abbas
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204 views41 pages

Undergraduate Ent Radiology: Dr. Davis Thomas Pulimoottil

This document provides guidance on reporting key details in radiology reports. It discusses how to describe 7 key pieces of information for various types of x-rays, including whether they are plain or contrast images, the body part and view. For x-rays of the mastoids, it outlines the normal structures seen on Law's view and how to differentiate pathologies. For sinus x-rays, it discusses evaluating haziness and common findings. It also provides details on evaluating nasopharyngeal, neck, and chest x-rays, including describing the appearance and levels of foreign bodies.

Uploaded by

Asif Abbas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

UNDERGRADUATE ENT

RADIOLOGY

DR. DAVIS THOMAS PULIMOOTTIL


7 THINGS TO MENTION IN EACH X-
RAY:

1. Plain / contrast
2. X-ray / CT / MRI
3. Part of body (both mastoids / nose and PNS)
4. View (Law’s view / Water’s view/ AP view)
5. Normal structures (list anterior -posterior or
superior –inferior)
6. Abnormal pathology or anatomical variant
7. Probable diagnosis
PLAIN X-RAY BOTH
MASTOIDS LAWS VIEW
PLAIN X-RAY BOTH MASTOIDS
LAWS VIEW
PLAIN X-RAY BOTH MASTOIDS LAWS
VIEW
 Why take X-ray of both mastoids?
 To compare the normal anatomy of the 2 sides

 What is Law’s view?


 15° lateral oblique view

 Why take Law’s view?


 To prevent superimposition of one mastoid over the opposite
mastoid
 To cause superimposition of the external and internal auditory
canal
PLAIN X-RAY BOTH MASTOIDS LAWS
VIEW
 Types of pneumatisation of mastoid:
 Cellular: 80% of the normal population
 Diploeic: 15% of normal population
 Sclerotic: 5% of normal population

 If Xray mastoids shows bilateral sclerotic mastoids,


what is the diagnosis?
 It may be either bilateral CSOM or may be a normal
variant as 5% of normal population have sclerotic
mastoids
PLAIN X-RAY BOTH MASTOIDS LAWS
VIEW
 Normal structures seen on X-ray both mastoids
Law’s view (from anterior to posterior):
 Condyle of mandible
 Glenoid fossa
 External and internal auditory canals superimposed
upon each other
 Tegmen plate (corresponds to middle fossa dura)
 Sinus plate (corresponds to sigmoid sinus)
 Sinodural angle (Citelli’s angle)
 Mastoid air cells
PLAIN X-RAY BOTH MASTOIDS
LAWS VIEW
PLAIN X-RAY BOTH MASTOIDS LAWS
VIEW
 Differences between Cholesteatoma cavity and
post-mastoidectomy cavity:
Cholesteatoma cavity Post-mastoidectomy cavity

Margins are regular Margins are irregular (due to new bone


formation)

Sclerosis of margins present (due to No sclerosis of margins


ongoing inflammatory process)

Cotton-wool appearance of -
cholesteatoma in the centre of the
cavity
Rim of air between the cotton-wool -
appearance and the margin of the
cavity
PLAIN X-RAY BOTH MASTOIDS
LAWS VIEW
 Differential diagnosis of cavity on X-ray
mastoids:
 1. Cholesteatoma cavity
 2. Post-mastoidectomy cavity
 3. Mega-antrum
 4. Dehiscent high rising jugular bulb
 5. Forward lying sigmoid sinus
 6. Eosinophilic granuloma
 7. Cholesterol granuloma
 8. Tuberculosis
 9. Malignancy temporal bone
 10. Long-standing / retained foreign body in mastoid
PLAIN X-RAY NOSE AND
PARANASAL SINUSES WATER’S
VIEW
PLAIN X-RAY NOSE AND PARANASAL
SINUSES WATER’S VIEW
PLAIN X-RAY NOSE AND PARANASAL
SINUSES WATER’S VIEW
PLAIN X-RAY NOSE AND PARANASAL
SINUSES WATER’S VIEW
PLAIN X-RAY NOSE AND PARANASAL
SINUSES WATER’S VIEW
PLAIN X-RAY NOSE AND PARANASAL
SINUSES WATER’S VIEW

 Occipitomental view with mouth open

 Nose-chin position

 Advantage: All the sinuses can be visualized


in a single X-ray
PLAIN X-RAY NOSE AND PARANASAL
SINUSES WATER’S VIEW

 Normal structures visualized:


 Frontal sinus
 Ethmoid sinuses
 Maxillary sinuses
 Spheniod sinus
 Bony septum
 Inferior turbinate
 Nasal cavity
 Orbit
 Zygomatic process
PLAIN X-RAY NOSE AND PARANASAL
SINUSES WATER’S VIEW
 When will you say there is sinus haziness?
 By comparing the sinus haziness with the orbital haziness – if the
sinus haziness is more than that of the orbital haziness, sinus
haziness is said to be there.

 Kernel sign / Cut coconut appearance:


 It is circumferential mucosal thickening of the maxillary sinuses
seen in Allergic rhinitis.

 Sites of attachment of maxillary antral polyps:


 Floor of maxillary sinus
 Lateral wall of maxillary sinus
PLAIN X-RAY SOFT TISSUE
NASOPHARYNX LATERAL VIEW
PLAIN X-RAY SOFT TISSUE
NASOPHARYNX LATERAL VIEW
PLAIN X-RAY SOFT TISSUE
NASOPHARYNX LATERAL VIEW
PLAIN X-RAY SOFT TISSUE
NASOPHARYNX LATERAL VIEW
PLAIN X-RAY SOFT TISSUE
NASOPHARYNX LATERAL VIEW
PLAIN X-RAY SOFT TISSUE
NASOPHARYNX LATERAL VIEW

 Normal structures visualized:


 Nasal cavity
 Hard palate
 Soft palate
 Roof and posterior wall of nasopharynx
PLAIN X-RAY SOFT TISSUE
NASOPHARYNX LATERAL VIEW

 What is the endoscopic grading of adenoid


hypertrophy?
 Grade I: Adenoid occupying >25% of the choanal
area
 Grade II: Adenoid occupying 25-50% of the choanal
area
 Grade III: Adenoid occupying 50-75% of the choanal
area
 Grade IV Adenoid occupying 75-100% of the choanal
area
PLAIN X-RAY SOFT TISSUE
NASOPHARYNX LATERAL VIEW

 What is crescent sign?


 This sign is used to differentiate between a mass
arising from the nasopharynx and a nasal mass
extending to the nasopharynx
 On a Plain Xray soft tissue nasopharynx lateral view, if
a crescent air is present anterior to a nasopharyngeal
soft tissue mass, it implies a nasopharyngeal mass.
 If the crescent of air is present posterior to the mass,
it implies a nasal mass extending to the nasopharynx.
PLAIN X-RAY SOFT TISSUE
NECK LATERAL VIEW
PLAIN X-RAY SOFT TISSUE NECK
LATERAL VIEW
PLAIN X-RAY SOFT TISSUE NECK
LATERAL VIEW
 Normal structures visualized are:
 Base of tongue
 Vallecula
 Epiglottis
 Hyoid bone
 Laryngeal and tracheal airway
 Prevertebral soft tissue shadow
 Cervical spine
PLAIN X-RAY SOFT TISSUE NECK
LATERAL VIEW
 Features of Acute Retropharyngeal Abscess on
plain X-ray soft tissue neck are:
 Pre-vertebral soft tissue widening (more than 1/3rd –
½ of the diameter of the body of the corresponding
vertebra)
 Straightening of cervical spine (due to paraspinal
muscle spasm)
 Presence of gas shadows in the prevertebral soft
tissue shadow (due to gas-forming organisms)
 Presence of air-fluid level (in case of abscess)
PLAIN X-RAY SOFT TISSUE NECK
LATERAL VIEW
 Causes of pre-vertebral soft tissue widening:

 Retropharyngeal abscess
 Infected foreign body
 Post-cricoid malignancy
PLAIN X-RAY SOFT TISSUE NECK
LATERAL VIEW
PLAIN X-RAY SOFT TISSUE NECK
LATERAL VIEW
 How to describe a foreign body:

 Radio-opaque
 Radio-lucent
 Radio-dense
PLAIN X-RAY SOFT TISSUE NECK
LATERAL VIEW
 How to describe the level of the foreign body:

 By counting the cervical spine from below


upwards
 The last cervical spine is C7
PLAIN X-RAY NECK AND CHEST –
AP AND LATERAL VIEWS
PLAIN X-RAY NECK AND CHEST – AP
AND LATERAL VIEWS
How to differentiate between tracheal
and oesophageal foreign bodies
AP view Lateral view
Trachea Edge on view Face-on view
Oesophagus Face-on view Edge-on view

Trachea (superior view) Oesophagus (superior view)


PLAIN X-RAY NECK, CHEST
AND ABDOMEN – AP VIEW
PLAIN X-RAY NECK, CHEST AND
ABDOMEN – AP VIEW
Halo sign / Double ring sign

 Button battery shows a


double-ring sign or a
halo sign in AP view
and step-off sign in the
lateral view .

 However, two
overlapping coins may
simulate a ‘halo’ sign
on X-ray 
THANK YOU

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