HEENTradiology-Table 1 Flashcards
When would you get plain views for HEENT
Adequate for upper airway compromise, routine sinus problems and initial work up of facial trauma
When do you do endoscopy in evaluation of HEENT?
Preferable where direct visualization and Biopsy are possible. Laryngoscopy and nasopharyngoscopy
Cold nodules indicate what in thyroid nuclear scan?
Cancer
Barium swallow is good for detecting what diseases?
Dysphagia, strokes, ALS, myasthenia, aspiration pneumonia and esophageal diverticula (Zenkers)
Reasons for ordering ENT studies
Atypical presentation, progressive symptoms or signs, determine the extent of a disease process, treatment failures, determine the need for referral to ENT, to define surgical options
ENT red flags
Chronic hoarseness in a smoker, neck masses, retroauricular pain and swelling, stridor, difficulty swallowing liquids, weight loss, unexplained fevers, sinus pain, antibiotic failures, clear rhinorrhea post-trauma, retrotympanic mass, unilateral hearing loss, tinnitus, loss of balance, facial weakness, facial trauma with palpable deformity, focal bone tenderness with fever and septic source, refractory sinus infection, pulsatile tinnitus and focal cranial nerve abnormalities
What are AP and Lateral views used for
Soft tissue detail for evaluation of the overall contour of the soft tissues of the neck
What views are required to view the odontoid process?
AP, lateral, right anterior oblique, left anterior oblique and open mouth AP
What sinuses does the lateral view evaluate?
Frontal, maxillary and sphenoid sinuses
What does the Waters view evaluate
Maxillary and frontal sinuses, anterior ethmoid air cells and orbital floors
What structures does the Caldwell view evaluate
Frontal sinuses and posterior ethmoid air cells
When might you get a head CT with contrast?
If you are looking for a tumor that might be vascular. Contrast enhances the images
What should you think of with pulsatile tinnitus
Glomus tumor- rare, slow-growing, hypervascular tumors that arise within the jugular foramen of the temporal bone
In what patients are MRIs contraindicated
Cardiac pacemaker (ferromagnetic), cochlear implants (aneurysm clips), and women in 1st trimester (avoid if possible)
What imaging study would you get to evaluate bone erosion associated with squamous/basal cell cancer with local invasion?
CT scan- high resolution
What imaging study would you get to evaluate soft tissue mass delineation associated with squamous/basal cell cancer with local invasion?
MRI
What causes exostoses?
Exposure to cold water
Who are at risk for developing malignant otitis externa? What are you concerned about with this? What imaging should you get for it?
Elderly, diabetic (increased risk of pseudomonas), osteomyelitis of outer petrous bone. Ct scan
What structures are considered external ear?
Auricle/pinna, External ear canal
What structures are considered middle ear?
TM, ossicles, middle ear cleft (chamber)
What is chronic suppuritive OM, and what is a complication that can occur with this? What is the Tx?
Perforated TM with persistent drainage from middle ear (lasting >6-12 weeks), can cause a cholesteatoma. Tx always includes tympanomastoid surgery
What imagine study would you use to evaluate chronic suppuritive OM, why?
CT- concerned for bone destruction by cholesteatoma
What is otosclerosis? What are the two types? What imaging study would you getto evaluate?
Hardening of the bony tissue in the ear caused by abnormal bone remodeling in the middle ear. Fenestral and restrofenestral. CT scan –high resolution
What is Fenestral otosclerosis
Stapes foot plate fused to oval window
What is restrofenestral otosclerosis
Osteoporosis of the bone surrounding the cochlea and labyrinth
What is venous sinus thrombosis? What imaging study should you get? Complications?
Thrombosis due to sepsis extension into posterior wall of mastoid and lateral venous sinus. CT scan or MRI. Extradural empyema, subdural empyema, cerebral abscess
What structures are considered inner ear?
Cochlea, semicircular system, CN8
How does an acoustic neuroma present?
Asymmetric sensorineural hearing loss, tinnitis
What imaging study would you get to evaluate for acoustic neuroma?
MRI- high resolution with attention to the internal auditory canal (IAC)
What is this an image of?
Acoustic neuroma
True or false: Facial nerve palsy always needs immediate imaging
False- facial nerve palsy is usually not imaged
What imaging study would you get for trauma concerning inner ear?
CT scan- high resolution
Basal skull fractures may involve what bone? What is this associated with?
Petrous bone. Associated with CSF leak, facial nerve damage, ossicular chain disruption (loss of normal alignment between the three inner ear ossicles. The condition is a cause of conductive hearing loss)
What imaging study would you get to evaluate for congenital malformations of the inner ear? What are some things evaluated by this imaging study?
CT scan- high resolution/MRI is complementary to CT.
Cochlea- basal turn structure, number of turns
vestibule- enlargement
Semicircular canals- absent or morphological abnormalities
Ossicles- fused or malformed
Oval and round window- position/orientation
Water’s view magnifies what sinuses?
Maxillary/frontal
What is this?
Left maxillary mucous retention cyst (mucocele)
What is on the left , right in this. What imaging modality is this?
Left- mucocele
Right- polyp
What is this image showing?
Maxillary sinusitis
What is this image showing?
Frontal sinusitis
What type of image is this, what is it showing
MRI- Ethmoid sinusitis with left extension into orbit
List the areas of mandibular fracture from most common to least common
Condyle- 30% Angle 25%, Body 25% Parasymphyseal/mental 15% Ramus- 3% Coronoid process- 2%
What is this image showing?
Mandibular condylar fracture
What is this?
Mandibular condylar fracture
WHAT IS THIS?!?!?
Mandibular tumor
What is this?
TMJ sclerosis
What might you see on laryngoscopy of an opera singer?
Laryngeal polyps- frequently result from vocal use/misuse (excessive loudness in teacher, singing excessively with poor breath support in a singer).. these are benign
What image would you get in a child with inspiratory stridor. What do you expect to see?
Neck Xray- expect to see the steeple sign, showing a tapering or narrowing of the airway below the vocal cords
What is this?
Steeple sign, suggestive of croup or laryngotracheobronchitits
What is this? What is it associated with? How is it treated?
Thumb sign, epiglottis , IV antibiotics
What is this?
Laryngeal cancer
What is this?
Retropharyngeal abscess
What is this study? What is the finding?
Barium swallow, zenker’s diverticulum
What is presbyesophagus?
Abnormal shape of the esophagus
What is this?
Presbyesophagus
When is US used in thyroid disease?
Used to differentiate solid vs cystic soft tissue lesions and thyroid nodules
Technetium-99 is used in the evaluation of what?
Radionucleotide scan Salivary gland function in autoimmune disease, salivary obstruction, can be pathognomonic of certain tumors
I-123 and I-131 are used to evaluate for what?
Thyroid imaging- uptake hot:cold nodules, thyroid ablation
What is this?
Multinodular goiter
What is this? What is this concerning for?
Cold nodule, thyroid 123-I
What is this?
Sialolithiasis
Sialolithiasis
What is this
Sialolithiasis
What is this?
Sialgogram- used to diagnose a blocked salivary gland or duct
What is this?
Parotid tumors
What is this?
Tongue cancer with invasion into mandible
What is this and what is it used for?
Useful for evaluating vascular compression and vessel encasement and patency, but full characterization of tumor vascularity and vascular malformations is suboptimal.
What is gold standard for imaging vascular lesions
CT angiography
What is this?
Carotid angiogram
What is this?
AV malformation of the middle cerebral artery
