3/18/2014 1 Advanced ENT Imaging Tanya J. Rath, MD Director of head and Neck Imaging Assistant Professor University of Pittsburgh Medical Center University of Pittsburgh School of Medicine Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA Objectives • Review what studies to order for common clinical scenarios • Demonstrate the appropriate use of CT, MRI, US and fluoroscopy to characterize ENT pathology • Case based review of invasive sinus disease, neck masses, peritonsillar abscess, SSCD Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA Sinus Disease
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3/18/2014
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Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
Advanced ENT Imaging
Tanya J. Rath, MD
Director of head and Neck ImagingAssistant Professor
University of Pittsburgh Medical CenterUniversity of Pittsburgh School of Medicine
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
Objectives
• Review what studies to order for common clinical scenarios
• Demonstrate the appropriate use of CT, MRI, US and fluoroscopy to characterize ENT pathology
• Case based review of invasive sinus disease, neck masses, peritonsillar abscess, SSCD
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
Sinus Disease
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Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
Sinus Disease
• Inflammatory/Infectious
• Neoplasm and tumor‐like
• Granulomatous Disease
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
Sinusitis
Indications for imaging:• Not responding to treatment• Clinical features concerning for complications
– Intracranial, Intra‐orbital
• High risk patients– transplant, DM
What to order?• Sinus CT
– Routine – non‐contrast– Contrast for periorbital or facial swelling, clinical suspicion for intracranial extension or abscess, failing treatment
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
42 y.o. male chronic sinusitis, left orbital pain &periorbital swelling
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Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
36 y.o. female with sinusitis clinically, severeheadache worsening on antibiotics
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
Complications of Sinusitis
• Orbital and facial cellulitis
• Subperiosteal abscess – Pus between osseous orbital wall and periorbitaCommon with ethmoid sinusitis
– Represents 20% of orbital complications of sinusitis
• Epidural abscess
• Venous Occlusive Disease
• Brain Abscess
• Meningitis
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
19 y.o. male with supraorbital swelling and facial pain
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Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
19 y.o. male with supraorbital swelling and facial pain
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
Pott’s Puffy Tumor
• 1760 Sir Percivall Pott
• Subperiosteal abscess of the frontal bone, localized forehead swelling and frontal bone osteomyelitis
• Most common in teens
• Treatment IV Abx and surgery
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
54 year old with sinus congestion and headaches
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Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
Odontogenic sinusitis
• Inflammation of maxillary sinus due to odontogenic inflammatory disease or violation of sinus during dental procedure
• Treatment:
– Antibiotics
– Extraction or endodontic treatment; oralantral fistula repair
– Sinus surgery if ostium blocked
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
56 y.o. female h/o DM and renal transplant c/o facial pain and congestion
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
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Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
60 y.o. female h/o RA, recent sinusitis with new left diplopia and proptosis
Fourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PAFourth Annual ENT for the PA-C | April 24-27, 2014 | Pittsburgh, PA
60 y.o. female h/o RA, recent sinusitis with new left diplopia and proptosis
Invasive Fungal Sinusitis
• Rapidly progressive fungal sinusitis involving bone & adjacent soft tissues; usually immunocompromised