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Apuntes de Fisiología, Anatomía-radiológicaclínica
Seminarios Clínica de Asma y Alergia II.Parte

CT Scan Sinusitis Crónica
Lean las notas al pie de las diapositivas
14/04/12 Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Anatomía y Patología Rinosinusal Anotaciones para Médicos Generales y Especialistas de Vias Respiratorias
Revisión Dr. Juan Herrera Salazar Clínica de Asma y Alergia
2 Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513 14/04/12

Dr. Juan Herrera Salazar
 Clínica

de Asma y Alergia, Dr. Juan Herrera Salazar…Facebook

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Foro Médico Nicaragüense Portales Médicos Medbook Mi blog de Asma y Alergia

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Bibliografía
Atlas Netter II edición. Atlas Netter IV edición Interactiva. Atlas, Anatomy,Carmine de Clemente 3rd

ed.. Gray’ s Anatomy Ed. Longman 1973.  Emedecine collection

Nasal Cavity Anatomy, Physiology, and Anomali
Seminarios Anatomía Clínico Radiológica Arlen D Meyers, Tel. 22781169,22703359, 88825513 4

Author: Belachew Tessema, MD; Chief Editor: MD, MBA. Updated: Mar 29, 2011 14/04/12

Bibliografía Emedecine
Nasal Physiology  Author: Sanford M

Archer, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...

Olfactory System Anatomy  Author: Amir

Vokshoor, MD; Chief Editor: Arlen D Meyers, MD, MBA   more... Nasal Aerodynamics  Author: Samuel J Lin, MD; Chief Editor: Arlen D Meyers, MD, MBA   more... Author: Ali Seminarios Anatomía Clínico Radiológica Tel. Sajjadian, MD, FACS; Chief Editor: Arlen 14/04/12 D 22781169,22703359, 88825513 Meyers, MD, MBA   more...
Nasal Reconstruction 

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“ Lo más dificil es ver lo que esta delante de tus ojos” W. Goethe

Seminarios Anatomía Clínico Radiológica 7 Tel. 22781169,22703359, 88825513

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Anatomia radiológica

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Radiografa Craneo Rx. . Lateral

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Anatomia y fisiología
Favor leer notas al

pie de pagina…..

……
o ….. o ….. o …..

Gracias
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Definiciòn de Sinusitis
Sinusitis is an inflammation of the mucosal

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lining of the paranasal sinuses. As the mucosa of the sinuses is continuous with that of the nose, rhinosinusitis is a more suitable term.[1, 2] Sinusitis can be subdivided into acute, subacute, and chronic disease. Acute sinusitis is defined as disease lasting less than 1 month. Subacute disease lasts 1-3 months, and chronic sinusitis lasts longer than 3 months and is generally related to suboptimally treated acute or subacute Seminarios Anatomía Clínico Radiológica Tel. 14/04/12 22781169,22703359, 88825513 disease. Acute and subacute sinusitis are

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Radiografía de los Senos Nasales
Waters

(occipitomental) Caldwell (occipitofrontal)
Vista Lateral Vista basilar

( the right Polypoid mucosal thickening in submento-vértice) maxillary sinus with a mucous retention cyst in the left on a Waters view.
13 Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513 14/04/12

Derrame del seno maxilar…
Air-fluid

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

levels, as shown in the image below, generally indicate bacterial sinusitis.

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Tratamiento antibiótico
Levofloxacin,

moxifloxacin, and amoxicillin/clavulan ate - Greater than 90%
High-dose

Clindamycin,

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amoxicillin, cefpodoxime proxetil, cefixime, cefuroxime axetil, and trimethoprimSeminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513 sulfamethoxazole -

doxycycline, cefprozil, azithromycin, clarithromycin, and erythromycin - 7080%
Cefaclor - 50-60%
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Otros medicamentos Rinosinusitis
Decongestionantes…Ver notas Limpieza con solución Expectorants docs jhs  salina… ver Nasal 2 spray… Corticosteroids Anticholinergics

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Diagnóstico diferencial
Allergic Fungal Sinusitis Sinusitis, Chronic, Medical Treatment Sinusitis, Ethmoid, Acute, Surgical Treatment Sinusitis, Frontal, Acute, Surgical Treatment Sinusitis, Fungal

Sinusitis, Maxillary, Acute, Surgical Treatment Sinusitis, Maxillary, Chronic, Surgical Treatment Sinusitis, Sphenoid, Acute, Surgical Treatment

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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CT Scan Anatomía y Fisiología
CT scan, nasal

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

cavity. Normal anterior ostiomeatal complex anatomy. The anatomy of the ethmoid infundibulum and the uncinate process is demonstrated 14/04/12 here.

CT Scan Anatomía y Fisiología

 The uncinate process

COM Complejo Osteo Meatal
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(UP) and lateral wall of the nasal cavity form the ethmoid infundibulum (EI). The above sinuses drain into the EI via various ostia. The maxillary sinus ostia and the frontal sinus recess or duct drain into the anteriormost portion of the OMC and are consistently identifiable on CT scan. Normal frontal recess/duct. Frontal sinus empties into the middle meatus just lateral to the 14/04/12

CT Scan Anatomía y Fisiología

Stammberger and

Messerklinger Drainage…
Normal posterior

Complejo Osteo Meatal Posterior Normal
20 Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

ostiomeatal complex. The vomer separates the two ostia into the sphenoid sinus. These ostia are located in the sphenoethmoid 14/04/12 recess. The

CT Scan Anatomía y Fisiología

A normal sagittal

Complejo Osteo Meatal Posterior Normal
21 Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

reconstruction of the OMC, showing the curved edge of the semilunar hiatus with the inferior mucosal edge covering the UP, can be seen in the image below. The frontal recess is also shown.

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El septo nasal
Desviación del

Septo

Fisiología de las desviaciones del Septo Nasal… Factor predisponente…. Sinusitis… Ver el papel de las alergias…

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Septo Nasal Estructura Osea y Cartilaginea.

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Anomalías de la Cavidad Nasal
 Fusion (apparent) of

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

uncinate process to the ethmoid floor. Note the normal uncinate process on the other side. Airway flow is compromised from the sinuses to the middle meatus because of the functionally occluded semilunar hiatus. Because the maxillary sinus is 14/04/12

Anomalías de la Cavidad Nasal
 Congenital or true

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

fusion of the uncinate process to the orbit floor. The maxillary sinus is hypoplastic and not aerated. The ethmoid infundibulum does not exist or ends blindly as the recessus terminalis.  The UP tip can also fuse directly to the lateral wall or lamina papyracea of the orbit. This anomaly produces the same 14/04/12 imaging findings as

Anomalías de la Cavidad Nasal
Bilateral pneumatization of the uncinate tips. Expansion of the tips can compromise the ethmoid infundibulum, the semilunar hiatus, or the middle meatus.

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Anomalías de la cavidad nasal
  Concha bullosa of

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

the left middle turbinate with expansion and narrowing of the ethmoid infundibulum and the middle meatus. Note absence of the right uncinate process, another 14/04/12 anatomic variant.

Anomalías de la cavidad nasal
Turbinatos   Anomalías del

paradójicos Duplicados Accesorios Fusión turbinatoturbinato

proceso uncinato.
Conchae

( anomalías)

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Anomalías de la cavidad nasal
 

 Large Haller air cell clearly narrowing the ethmoid infundibulum.

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Anomalías de la cavidad nasal

Overexpansion of

the ethmoid sinus floors

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Anomalías de la Cavidad Nasal
Polipos nasales Polipos coanales Turbinatos Absence of basal

accesorios Fracturas
Cirugía FESS

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

or ground lamella Absence of the basal or ground lamella is problematic only if FESS of the posterior OMC is being considered.. Bony septa: N.Videano 14/04/12 Lesiones

Características radiológicas de la sinusitis
El Nivel Hidro-aereo, en el seno maxilar sugiere sinusitis.

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Patrones radiólogicos al CT Scan
Right-sided sphenoethmoid al pattern of sinusitis.

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Patrones radiólogicos al CT Scan
Bilateral ethmoid sinusitis on an MRI.

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Hiatus semilunaris
 Es el espacio delimitado

entre el proceso uncinato anteoinferior y la bula etmoidal
 Las celdas etmoidales

 El infundibulum

anteriores drenan anteriormente en el hiatus semilunaris atraves del ducto fronto nasal.The middle group drains into the hiatus semilunaris on or above the ethmoidal bulla.
 El seno frontal drena

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por medio del ducto frontal o a través de las Seminarios Anatomía Clínico Radiológica Tel. celdas etmoidales 22781169,22703359, 88825513 anteriores en el hiatus

maxilar drena en la regiòn posterior del hiatus semilunaris.  El seno frontal, maxilar, las celdas anteriores y mediales drenan en el hiatus semilunaris.  Cualquier obstaculo mecanico en esta regiònm causa inflamaciòn de los senos mencionados. Esto se le conoce como patron 14/04/12 osteomeatal.

El Complejo Osteo Meatal
Anatomia: Para evaluar el Turbinate Medio Bulla Etmoidal Proceso Uncinato Infundibulo Maxilar Hiatus semilunaris

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patrón de una sinusitis debemos conocer primero el drenaje de los senos nasales. Unidad Osteomeatal: esta no es una estructura morfológica única Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513 sino una

(espacio debajo del turbinato) Hueso Maxilar

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Complejo Osteomeatal

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

Mucosal thickening in the left anterior ethmoid and maxillary sinuses and in the region of the infundibulum. This indicates an ostiomeatal pattern of sinusitis 14/04/12

Estructura Osea pared lateral de la cavidad nasal, resección parcial turbinatos

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Pared lateral de la cavidad nasal

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Drenaje del seno esfenoidal
The sphenoid sinus drains posterior to

the superior turbinate into the sphenoethmoid recess through the sphenoid ostium. The posterior ethmoid air cells also drain through the superior meatus into the sphenoethmoid recess.
An obstruction in this region gives rise
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to the sphenoethmoid pattern of Seminarios Anatomía Clínico Radiológica Tel. sinusitis. 22781169,22703359, 88825513

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Conca Bulosa

Concha bullosa of the right middle turbinate.

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Celdas de Haller
Paradoxical curves

of both middle turbinates cause narrowing of the ostiomeatal units.

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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CT Scan Metodo Preferido
 Computed tomography (CT)

scanning is the examination of choice in sinusitis, particularly in cases of chronic sinus disease, providing excellent detail of sinus anatomy. However, CT is usually not useful in acute sinusitis, as diagnosis in acute cases is primarily based on clinical findings. Good anatomic definition is desirable before surgical intervention.
 Coronal CT imaging is the

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preferred initial procedure. Bone-window views provide excellent resolution and good definition of the complete ostiomeatal complex and other anatomic details that play a role Seminarios Anatomía Clínico Radiológica Tel. in sinusitis. In addition, the 22781169,22703359, is best correlated coronal view 88825513

CT provides an excellent anatomic display of softtissue attenuation. This depiction includes fluid levels and polypoid masses within the normally air-filled cavities of the sinuses, nasal cavity, and postnasal space. Most important, disease extending beyond the bony perimeters of the sinuses into the adjacent soft tissue of the orbit,[7] brain, and infratemporal fossa can be imaged. In general, nonenhanced CT scans suffice in cases of uncomplicated sinusitis. Multisection CT seems to have the potential to replace primary coronal CT of the 14/04/12 paranasal sinuses without

CT scan Spiral CT scan …

 Despite advances in MRI

1mm cuts Magnetic Resonance Imaging
 The exclusive use of coronal CT

technology, insufficient tissue, plus the problems of susceptibility due to the aircontaining passages, make MRI a less effective study for nasal cavity sinusitis problems, unless of course the sinusitis turns out to be related to squamous cell carcinoma (SCCa).
 To date, no new MRI contrast

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scans for sinus imaging could result in the failure to diagnose nasal cavity neoplasms. In the absence of bone destruction, an esthesioneuroblastoma or other neoplasm may be mistaken for a nasal polyp on a CT scan, whereas on MRI, the nature of this tumor is quite apparent. Beyond anatomic Seminarios Anatomía Clínico Radiológica Tel. variants, any suspicious findings 22781169,22703359, 88825513 should be imaged by means of MRI

agents that have an affiliation for SCCa have been released

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Próxima serie parte…
Magnetic

III

Resonance Imaging
Ultrasonography Nuclear Imaging Angiography

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Gracias !

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Seminarios Anatomía Clínico Radiológica Tel. 22781169,22703359, 88825513

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Gracias por la oportunidad
 Clínica

de Asma y Alergia, Dr. Juan Herrera Salazar…Faceb

.

Desde la Clínica de Asma y Alergia

Managua , Nicaragua. Tel 22781169, 22703359, 88825513 Dr. Juan Herrera Salazar… Favor ver la VI parte para pacientes…
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