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Apuntes de Fisiologa,Apuntes de Fisiologa,
Anatoma-radiolgica-Anatoma-radiolgica-clnicaclnica
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CT ScanSinusitis CrnicaLean las notas al pie de las
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RevisinDr. Juan Herrera Salazar
Clnica de Asma y Alergia
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Anatoma y Patologa
RinosinusalAnotaciones para
Mdicos Generales yEspecialistas de Vias
Respiratorias
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Dr. Juan Herrera Salazar
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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/2409445492622378/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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Bibliografa
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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-overview8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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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-overview8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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Lo ms dificil es ver lo que esta delante de tusojos W. Goethe
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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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Polypoid mucosal thickening in the rightmaxillary sinus with a mucous retention cyst inthe left on a Waters view.
8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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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%20108/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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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-overview8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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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
8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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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
8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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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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Anomalas de la CavidadNasal
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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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Anomalas de la CavidadNasal
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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 de la cavidadnasal
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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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Anomalas de la cavidadnasal
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Large Haller air cellclearly narrowing the
ethmoid infundibulum.
l d l id d
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Anomalas de la cavidadnasal
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
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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
8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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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.
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Conca Bulosa
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Concha
bullosa ofthe rightmiddle
turbinate.
8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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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
8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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Prxima serie IIIparte
MagneticResonance Imaging
Ultrasonography
Nuclear Imaging
Angiography
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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-overview8/4/2019 Apuntes de Radiologa Rinosinusal CT Scan Sinusitis V parte
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Gracias!
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Seminarios Anatoma Clnico Radiolgica Tel.
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
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