Ear / Nose / Throat, CT, MR, Ultrasound, Complications, Diagnostic procedure, Education, Acute, Infection, Inflammation
Findings and procedure details
Findings: We have provided some examples from our own practice that include both tertiary hospitals and private practice experience.
Most cases have 2 or 3 slides. The first slide will show history and imaging findings. In some cases first slide is without legends and arrows- this is to stimulate thinking for the readers and make a provisional diagnosis in their own minds. The second set of slides will be illustrative with arrows and legends, providing diagnosis and pertinent imaging findings
The causes, imaging findings and potential complications of each entity will be discussed subsequently.
Some take-home points are:
- In patients with maxillary sinus opacification, always check the teeth to look for a potential odontogenic cause.
- Peritonsillar abscess occurs after the infection penetrates the fibrous tonsillar capsule and is treated differently from tonsillitis.
- Acute onset hearing loss- have a thorough look at the labyrinthine signal. Both labyrinthitis and labyrinthine haemorrhage will have high Flair signal but the latter will be bright on pre-contrast T1.
- Coalescent mastoiditis- always scrutinize the intracranial compartment for potential complications.
- Bulging lateral walls of cavernous sinus- have a high suspicion for cavernous sinus thrombosis.
- Sinus mucosal disease in immunocompromised patients-have a very high index of suspicion for invasive fungal sinusitis. Some of the earliest signs are nasal cavity asymmetric soft tissue and mucosal erosion, stranding of the peri and/or retro-antral fat. These can be very subtle.
- Retropharyngeal fluid- always check for contrast enhancement and any suppurative lymphadenopathy for retropharyngeal abscess.
- If a retropharyngeal abscess is suspected always scan up to the mediastinum.
- Carotidynia is a diagnosis of exclusion.