Apuntes de Radiología Rinosinusal CT Scan Sinusitis V parte

8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte

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14/04/12Seminarios Anatoma Clnico Radiolgica Tel.

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Apuntes de Fisiologa,Apuntes de Fisiologa,

Anatoma-radiolgica-Anatoma-radiolgica-clnicaclnica

SeminariosClnica de Asma y AlergiaII.Parte

CT ScanSinusitis CrnicaLean las notas al pie de las

diapositivas

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


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RevisinDr. Juan Herrera Salazar

Clnica de Asma y Alergia


22781169,22703359, 888255132

Anatoma y Patologa

RinosinusalAnotaciones para

Mdicos Generales yEspecialistas de Vias

Respiratorias


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Dr. Juan Herrera Salazar


22781169,22703359, 888255133

Clnica de Asma y Alergia, Dr. Juan Herrera SalazarFaceboo.

Foro Mdico NicaragensePortales Mdicos

Medbook

Mi blog de Asma y Alergia
http://www.facebook.com/pages/Cl%C3%ADnica-de-Asma-y-Alergia-DrJuan-Herrera-Salazar/240944549262237http://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://www.facebook.com/pages/Cl%C3%ADnica-de-Asma-y-Alergia-DrJuan-Herrera-Salazar/240944549262237


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Bibliografa

14/04/12Seminarios Anatoma Clnico Radiolgica

Tel. 22781169,22703359, 88825513

4

Atlas Netter II edicin.

Atlas Netter IV edicin Interactiva.

Atlas, Anatomy,Carmine de Clemente 3rded..

Gray s Anatomy Ed. Longman 1973.Emedecine collection

Nasal Cavity Anatomy, Physiology, and Anomal Author: Belachew Tessema, MD; Chief Editor:Arlen D Meyers, MD, MBA. Updated: Mar 29, 2011
http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://drjuanherrerasalazarasmayalergia.blogspot.com/http://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 MArcher, MD; Chief Editor: Arlen D Meyers,MD, MBA more...

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

MD; Chief Editor: Arlen D Meyers, MD, MBAmore...

Nasal Reconstruction Author: Ali

Sajjadian, MD, FACS; Chief Editor: Arlen DMeyers, 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/874822-overviewhttp://emedicine.medscape.com/article/835585-overviewhttp://emedicine.medscape.com/article/874771-overview


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

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Seminarios Anatoma Clnico Radiolgica

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Anatomia radiolgica


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r r n x. .Lateral


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Anatomia y fisiologa


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Favor leer notas alpie de pagina..

o ..

o ..

o ..Gracias


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Definicin de SinusitisSinusitis is an inflammation of the mucosal

lining of the paranasal sinuses. As themucosa of the sinuses is continuous withthat of the nose, rhinosinusitis is a more

suitable term.[1, 2]

Sinusitis can be subdivided into acute,subacute, and chronic disease. Acutesinusitis is defined as disease lasting less

than 1 month. Subacute disease lasts 1-3months, and chronic sinusitis lasts longerthan 3 months and is generally related tosuboptimally treated acute or subacute

disease. Acute and subacute sinusitis are14/04/12Seminarios Anatoma Clnico Radiolgica Tel.

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Radiografa de los SenosNasales

Waters(occipitomental)

Caldwell(occipitofrontal)

Vista Lateral

Vista basilar( submento-vrtice)

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Seminarios Anatoma Clnico Radiolgica Tel.

22781169,22703359, 8882551313

Polypoid mucosal thickening in the rightmaxillary sinus with a mucous retention cyst inthe left on a Waters view.


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Derrame del senomaxilar

Air-fluid

levels, asshown in theimage below,

generallyindicatebacterialsinusitis.

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Tratamiento antibiticoLevofloxacin,

moxifloxacin, andamoxicillin/clavulanate - Greater than

90%

High-doseamoxicillin,cefpodoximeproxetil, cefixime,cefuroxime axetil,and trimethoprim-sulfamethoxazole -

Clindamycin,doxycycline,cefprozil,azithromycin,clarithromycin, anderythromycin - 70-80%

Cefaclor - 50-60%

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Otros medicamentosRinosinusitisDecongestionantesVer notasLimpieza con solucin salina ver docs jhs

Nasal 2 spray

Expectorants

Corticosteroids

Anticholinergics

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http://emedicine.medscape.com/article/232670-medication#Slide%2010http://emedicine.medscape.com/article/232670-medication#Slide%2010http://emedicine.medscape.com/article/232670-medication#Slide%2010http://emedicine.medscape.com/article/232670-medication#Slide%2010http://emedicine.medscape.com/article/232670-medication#Slide%2010http://emedicine.medscape.com/article/232670-medication#Slide%2010


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Diagnstico diferencialAllergic Fungal SinusitisSinusitis, Chronic, Medical Treatment

Sinusitis, Ethmoid, Acute, Surgical Treatment

Sinusitis, Frontal, Acute, Surgical TreatmentSinusitis, Fungal

Sinusitis, Maxillary, Acute, Surgical Treatment

Sinusitis, Maxillary, Chronic, Surgical Treatmen

Sinusitis, Sphenoid, Acute, Surgical Treatment

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http://emedicine.medscape.com/article/834401-overviewhttp://emedicine.medscape.com/article/861768-overviewhttp://emedicine.medscape.com/article/862183-overviewhttp://emedicine.medscape.com/article/862292-overviewhttp://emedicine.medscape.com/article/863062-overviewhttp://emedicine.medscape.com/article/862030-overviewhttp://emedicine.medscape.com/article/861886-overviewhttp://emedicine.medscape.com/article/862435-overviewhttp://emedicine.medscape.com/article/862435-overviewhttp://emedicine.medscape.com/article/861886-overviewhttp://emedicine.medscape.com/article/862030-overviewhttp://emedicine.medscape.com/article/863062-overviewhttp://emedicine.medscape.com/article/862292-overviewhttp://emedicine.medscape.com/article/862183-overviewhttp://emedicine.medscape.com/article/861768-overviewhttp://emedicine.medscape.com/article/834401-overview


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CT Scan Anatoma yFisiologa

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CT scan, nasalcavity.

Normal anteriorostiomeatalcomplex anatomy.

The anatomy of the

ethmoidinfundibulum andthe uncinateprocess is

demonstratedhere.


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Anatoma yFisiologa

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The uncinate process(UP) and lateral wallof the nasal cavity

form the ethmoidinfundibulum (EI).The above sinuses

drain into the EI viavarious ostia. Themaxillary sinus ostia

and the frontal sinusrecess or duct draininto the anterior-most portion of theOMC and are

consistentlyidentifiable on CTscan. Normal frontalrecess/duct. Frontalsinus empties intothe middle meatus

just lateral to the

COMComplejo Osteo

Meatal


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Anatoma yFisiologa

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Stammberger andMesserklinger

Drainage

Normal posteriorostiomeatal

complex. Thevomer separatesthe two ostiainto the sphenoid

sinus. Theseostia are locatedin thesphenoethmoid

recess. The

Complejo OsteoMeatal Posterior

Normal


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Anatoma yFisiologa

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A normal sagittalreconstruction of

the OMC, showingthe curved edge ofthe semilunarhiatus with the

inferior mucosaledge covering theUP, can be seen inthe image below.

The frontal recessis also shown.

Complejo Osteo

Meatal PosteriorNormal


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El septo nasal

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Desviacin delSepto

Fisiologa de las desviaciones del SeptoNasal

Factor predisponente. SinusitisVer el papel de las alergias


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Estructura Osea y

Cartilaginea.

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Anomalas de la CavidadNasal

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Fusion (apparent) ofuncinate process tothe ethmoid floor.Note the normal

uncinate process onthe other side. Airwayflow is compromisedfrom the sinuses tothe middle meatusbecause of thefunctionally occludedsemilunar hiatus.Because the

maxillary sinus is


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Congenital or truefusion of the uncinateprocess to the orbitfloor. The maxillarysinus is hypoplasticand not aerated. Theethmoidinfundibulum doesnot exist or endsblindly as therecessus terminalis.

The UP tip can alsofuse directly to thelateral wall or laminapapyracea of theorbit. This anomaly

produces the sameimaging findings as


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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 cavidadnasal

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Concha bullosa of

the left middleturbinate with

expansion andnarrowing of theethmoidinfundibulum and

the middle meatus.Note absence ofthe right uncinateprocess, another

anatomic variant.


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Anomalas del

proceso uncinato.

Conchae( anomalas)

Turbinatosparadjicos

Duplicados

Accesorios

Fusin turbinato-turbinato

l d l id d


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Large Haller air cellclearly narrowing the

ethmoid infundibulum.

l d l id d


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Overexpansion ofthe ethmoid sinus

floors

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A l d l C id d


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Anomalas de la CavidadNasalPolipos nasalesPolipos coanales

Turbinatosaccesorios

Fracturas

Absence of basalor groundlamellaAbsence of the

basal or groundlamella isproblematic only ifFESS of the

posterior OMC isbeing considered..

Bony septa:N.Videano

Lesiones14/04/12


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Ciruga FESS

C t ti


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Caractersticasradiolgicas de la sinusitis

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El NivelHidro-aereo,

en el senomaxilarsugieresinusitis.

P t dil i l CT


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Patrones radilogicos al CTScan

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Right-sided

sphenoethmoidal pattern ofsinusitis.

P t dil i l CT


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Patrones radilogicos al CTScan

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Bilateral

ethmoidsinusitis on anMRI.


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Hiatus semilunaris Es el espacio delimitado

entre el procesouncinato anteoinferior yla bula etmoidal

Las celdas etmoidalesanteriores drenan

anteriormente en elhiatus semilunarisatraves del ductofronto nasal.The middlegroup drains into thehiatus semilunaris on orabove the ethmoidalbulla.

El seno frontal drenapor medio del ductofrontal o a travs de las

celdas etmoidalesanteriores en el hiatus

El infundibulummaxilar drena en laregin posterior delhiatus semilunaris.

El seno frontal,

maxilar, las celdasanteriores y medialesdrenan en el hiatussemilunaris.

Cualquier obstaculo

mecanico en estareginm causainflamacin de lossenos mencionados.Esto se le conoce

como patronosteomeatal.14/04/12


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El Complejo Osteo MeatalAnatomia:Para evaluar el

patrn de unasinusitis debemos

conocer primero eldrenaje de lossenos nasales.

UnidadOsteomeatal: estano es unaestructuramorfolgica nica

sino una

Turbinate MedioBulla Etmoidal

Proceso Uncinato

Infundibulo MaxilarHiatus semilunaris

(espacio debajodel turbinato)

Hueso Maxilar

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Complejo Osteomeatal

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Mucosal

thickening inthe leftanterior

ethmoid and

maxillarysinuses and inthe region of

theinfundibulum.

This indicatesan

ostiomeatalpattern of

sinusitis

Estructura Osea pared lateral de la


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Estructura Osea pared lateral de lacavidad nasal, reseccin parcialturbinatos

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P d l t l d l


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Pared lateral de lacavidad nasal

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Drenaje del seno esfenoidal

The sphenoid sinus drains posterior tothe superior turbinate into thesphenoethmoid recess through the

sphenoid ostium.The posterior ethmoid air cells also

drain through the superior meatusinto the sphenoethmoid recess.

An obstruction in this region gives riseto the sphenoethmoid pattern of

sinusitis. 14/04/12Seminarios Anatoma Clnico Radiolgica Tel.

22781169,22703359, 8882551341


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Conca Bulosa

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Concha

bullosa ofthe rightmiddle

turbinate.


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Celdas de Haller

Paradoxical curvesof both middleturbinates causenarrowing of the

ostiomeatal units.

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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 ofsinus anatomy. However, CT isusually not useful in acute

sinusitis, as diagnosis in acutecases is primarily based onclinical findings. Good anatomicdefinition is desirable beforesurgical intervention.

Coronal CT imaging is the

preferred initial procedure.Bone-window views provideexcellent resolution and gooddefinition of the completeostiomeatal complex and otheranatomic details that play a rolein sinusitis. In addition, the

coronal view is best correlated

CT provides an excellent

anatomic display of soft-tissue attenuation. Thisdepiction includes fluidlevels and polypoid masseswithin the normally air-filledcavities of the sinuses, nasalcavity, and postnasal space.

Most important, diseaseextending beyond the bonyperimeters of the sinusesinto the adjacent soft tissueof the orbit,[7] brain, andinfratemporal fossa can be

imaged.In general, nonenhanced CT

scans suffice in cases ofuncomplicated sinusitis.Multisection CT seems tohave the potential to replaceprimary coronal CT of the

paranasal sinuses without14/04/12


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CT scanSpiral CT scan

1mm cuts

MagneticResonanceImaging

The exclusive use of coronal CTscans for sinus imaging could resultin the failure to diagnose nasal

cavity neoplasms. In the absence ofbone destruction, anesthesioneuroblastoma or otherneoplasm may be mistaken for anasal polyp on a CT scan, whereason MRI, the nature of this tumor isquite apparent. Beyond anatomicvariants, any suspicious findings

should be imaged by means of MRI.

Despite advances in MRItechnology, insufficient tissue,plus the problems ofsusceptibility due to the air-containing passages, make MRIa less effective study for nasalcavity sinusitis problems, unlessof course the sinusitis turns outto be related to squamous cellcarcinoma (SCCa).

To date, no new MRI contrastagents that have an affiliation

for SCCa have been released.

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Prxima serie III


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Prxima serie IIIparte

MagneticResonance Imaging

Ultrasonography

Nuclear Imaging

Angiography

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22781169,22703359, 8882551346
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-overview


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Gracias!


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Gracias por la oportunidad

Clnica de Asma y Alergia, Dr. Juan Herrera SalazarFaceb.

Desde la Clnica de Asma y AlergiaManagua , Nicaragua. Tel 22781169,22703359, 88825513

Dr. Juan Herrera Salazar

Favor ver la VI parte para pacientes
http://www.facebook.com/pages/Cl%C3%ADnica-de-Asma-y-Alergia-DrJuan-Herrera-Salazar/240944549262237http://www.facebook.com/pages/Cl%C3%ADnica-de-Asma-y-Alergia-DrJuan-Herrera-Salazar/240944549262237

Apuntes de Radiología Rinosinusal CT Scan Sinusitis V parte

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