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M-1 RADIOLOGY Head and Neck. OBJECTIVES Skull, Sinus and Orbit anatomy Vascular anatomy Neck anatomy Clinical cases.

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Presentation on theme: "M-1 RADIOLOGY Head and Neck. OBJECTIVES Skull, Sinus and Orbit anatomy Vascular anatomy Neck anatomy Clinical cases."— Presentation transcript:

1 M-1 RADIOLOGY Head and Neck

2 OBJECTIVES Skull, Sinus and Orbit anatomy Vascular anatomy Neck anatomy Clinical cases

3 SKULL ANATOMY

4 SINUSES PA view 1.Nasal Septum 2.Frontal Sinus 3.Maxillary Sinus 4.Ethmoid Sinus 5.Inferior Turbinate 6.Superior orbital fissure

5 1- Superior orbital fissure 2- Inferior orbital foramen 3- Mental foramen Fissures and foramen have nerves that show on lab practicals.

6 OPTIC CANAL

7 SINUSES 1. Frontal sinus 2. Zygomatic-Frontal Suture 3. Maxillary Sinus 4. Inferior orbital margin AP WATERS VIEW This view is angled to project the maxillary sinuses free of the petrous ridge.

8 Note the opacified right maxillary sinus with fluid layering dependently indicating sinusitis

9 Superior Inferior Medial Lateral WHAT RECTUS MUSCLE CAN BE INJURED BY EYE TRAUMA?

10 ORBITAL FLOOR FRACTURE Arrow points to bone fragment displaced into orbit. The inferior rectus muscle can become entrapped in fracture

11 CORONAL SCAN CT FACIAL CT scans redemonstrate fracture and edema at site.

12 1. Frontal Sinus 2. Maxillary Sinus 3. Ethmoid Sinus 4. Sphenoid Sinus LATERAL SINUS & SKULL

13 Middle meningeal artery

14

15 FRACTURE EPIDURAL HEMATOMA Cause: Laceration of the meningeal artery adjacent to inner table.

16 Normal skull Sella

17 CT SKULL BASE CAROTID CANAL JUGULAR FORAMEN

18 CT SKULL BASE MANDIBULAR CONDYLE MASTOID AIR CELLS PINNA

19 SKULL BASE FRACTURE

20 “RACCOON EYES” Periorbital ecchymosis is a sign of a basal skull fracture. Blood tracks along the periosteum and can collect in soft tissues of the orbital lid.

21 CT SKULL BASE ZYGOMATIC ARCH EXTERNAL AUDITORY CANAL

22 CT SKULL BASE FORAMEN OVALE FORAMEN SPINOSUM PETROUS CAROTID CANAL CLIVUS

23 CT SKULL BASE IAC INTERNAL AUDITORY CANAL CAROTID CANAL OSSICLES

24 Acoustic neuroma is a slow growing tumor that develops on the 8 th cranial nerve. Symptoms include unilateral loss of hearing, Tinnitus-ringing in ears. dizziness and vertigo.

25 SINUS AND ORBIT ANATOMY

26 SINUSES PA view 1.Frontal Sinus 2.Maxillary Sinus 3.Ethmoid Sinus 1 3 2

27 SINUSES 1.Frontal sinus 2. Zygomatic-Frontal Suture 3. Maxillary sinus 4. Inferior orbital margin AP WATERS VIEW This view is angled to project the maxillary sinuses free of the petrous ridge.

28 1. Frontal Sinus 2. Maxillary Sinus 3. Ethmoid Sinus 4. Sphenoid Sinus 5. Sella Turcica LATERAL SINUS & SKULL

29 1 1. Frontal Sinus CT- SINUS AXIAL VIEW Scans start superiorly and are shown going inferiorly

30 CT SINUS AXIAL SCAN normal Note the destroyed posterior wall of the left frontal sinus due to bacterial invasion.

31 1. Ethmoid sinus 2. Sphenoid sinus 3. Carotid canal CT- SINUS AXIAL VIEW

32 1.Maxillary sinus 2. Med. & Lat. Pterygoid plate 3.Nasopharynx 4.Nasal septum 5.Inferior turbinate CT- SINUS AXIAL VIEW

33 1.Fronto-nasal suture 2.Frontal sinus 3.Nasal bones CT- SINUS Coronal sections extending from anterior to posterior

34 1. Ethmoid sinus 2. Maxillary sinus 3. Middle turbinate 1 3 CT- SINUS CORONAL VIEW

35 CT- SINUS CORONAL VIEW Maxillary sinus

36 1.Sphenoid sinus 2.Hard palette 3.Anterior clinoid 1 CT- SINUS CORONAL VIEW 2 3

37 1.Retro orbital fat 2.Medial rectus 3.Lens 4.Lateral rectus 5.Optic nerve CT ORBIT AXIAL SCAN

38 CORONAL SCAN AXIAL SCAN MR SCAN Chiasm Optic nerves

39 In Biblical liturature who showed a knowledge of cranial nerve anatomy? Moses Noah David Goliath

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

41 NECK ANATOMY

42 LATERAL NECK 1.Hard palate 2.Soft palate 3.Nasopharynx 4.Oropharynx 5.Epiglottis

43 AIRWAY 1.Calcified tracheal cartilage rings 2.Hyoid bone 3.Epiglottis 4.Thyroid cartilage 5.Cricoid cartilage 5 LATERAL VIEW OF NECK

44 AIRWAY 1.Calcified tracheal cartilage rings 2.Hyoid bone 3.Epiglottis 4.Thyroid cartilage 5.Cricoid cartilage 5 LATERAL VIEW OF NECK

45 Where do you insert the tube at an emergency tracheostomy? Cricothyroid membrane

46 LATERAL VIEW OF NECK

47 SCAN LEVEL MAXILLARY SINUSES ZYGOMA SPHENOID SINUS LT Sections from the skull base extending inferiorly through the neck.

48 MASTOIDS NASOPHARYNX MAXILLA LT EXTERNAL AUDITORY MEATUS MANDIBULAR CONDYLE SCAN LEVEL

49 MANDIBLE PAROTID GLAND MASSETER MUSCLE MASSETER MUSCLE PTERYGOID MUSCLES LT

50 SCAN LEVEL SUBCUTANEOUS FAT SUBMANDIBULAR GLAND EPIGLOTTIS STERNOCLEIDOMASTOID MUSCLE LT

51 SCAN LEVEL HYOID BONE JUGULAR VEIN JUGULAR VEIN COMMON CAROTID ARTERIES LT VALLECULA PYRIFORM SINUS

52 SCAN LEVEL THYROID CARTILAGE VOCAL CORD STERNOCLEIDOMASTOID MUSCLE LT

53 SCAN LEVEL THYROID CARTILAGE CRICOID CARTILAGE JUGULAR VEIN COMMON CAROTID ARTERY LT

54 SCAN LEVEL CLAVICLE THYROID GLAND FAT LT TRACHEA ESOPHAGUS

55 SWALLOWING STUDY Note hyoid bone moves anteriorly and superiorly with swallowing.

56 THYROID SCAN Nuclear Medicine

57 THYROID SCAN SAGITTAL

58 SAGITTAL SCANS LEFT LOBE RIGHT LOBE

59 NUCLEAR MEDICINE NormalHypo-functional THYROID SCAN

60 PATIENT PRESENTS WITH WHEEZING AND NECK MASS IN MIDLINE AT STERNAL NOTCH

61 THYROID SCAN Nuclear Medicine Chest x-ray showing superior Mediastinal mass with displacement of the trachea to the right. Nuclear Medicine I 123 thyroid scan shows lobular mass extending inferiorly from the thyroid indicating a thyroid goiter accounting for displacement on chest x-ray.

62 CORONAL CT SCANS SHOWS THYROID LESION.

63 ARTERIOGRAM 1.Internal carotid artery 2.Intracranial carotid 3.Maxillary artery 4.Occipital artery 5.External carotid artery 6.Common carotid artery 7.Facial artery 1 7

64 WHAT VESSEL HAS TO BE LIGATED OR EMBOLIZED TO CONTROL EPISTAXIS IF PACKING NOSE FAILS? Maxillary Facial Lingual Superficial temporal

65 Here injection into the external carotid shows extravasation of blood from a branch of the maxillary artery compared with the normal. Maxillary artery normal

66 EMBOLIZATION Radiologist has directed a coil through the catheter to occlude vessels that were bleeding.

67 ASYMPTOMATIC BRUIT ON PHYSICAL EXAM

68 Abnormal Normal

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

70 HOARSENESS

71 NORMAL ASPIRATION A small amount of barium has spilled anteriorly with aspiration into the airway.

72 Hiatal hernia and reflux.

73 Here two patients with masses in their chest have involvement of the recurrent laryngeal nerve causing hoarseness due to vocal cord paralysis.

74 LARGE THORACIC ANEURYSM

75 LUNG MALIGNANCY

76 Amoebic meningitis can be contracted in southern states from swimming in warm lake water in summer by what route? Ear infection Aspiration into airway Mosquito bite Ethmoid transmission

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