Radiodiagnosis
ENT and Head and Neck Imaging
ENT and head and neck imaging for MBBS and NEET-PG: sinus and temporal bone CT, thyroid and neck ultrasound, and airway emergency signs, mapped to NMC code RD1.3.
MedNext Academy | 3 min read
ENT and Head and Neck Imaging
ENT and head and neck imaging for MBBS and NEET-PG: sinus and temporal bone CT, thyroid and neck ultrasound, and airway emergency signs, mapped to NMC code RD1.3.
This chapter covers imaging of the ear, nose, throat, sinuses, salivary glands and neck. It teaches when to use CT for bony detail such as the sinuses and temporal bone, MRI for soft-tissue masses and tumour spread, and ultrasound as the front-line test for thyroid nodules and cervical nodes, alongside the plain-film signs of airway emergencies.
High-yield: ENT and Head and Neck Imaging
- CT with bone windows is the modality of choice for the paranasal sinuses and for the fine bony detail of the temporal bone.
- The occipitomental (Water's) view is the plain radiograph traditionally used to show air-fluid levels and opacification in the maxillary sinuses.
- Sinus mucosal thickening, air-fluid levels and opacification support sinusitis, while bony erosion raises concern for invasive fungal disease or malignancy.
- MRI is superior to CT for soft-tissue characterisation of head and neck masses, nasopharyngeal carcinoma and perineural spread of tumour.
- Ultrasound is the first-line investigation for a thyroid nodule and for cervical lymph nodes, and it guides fine-needle aspiration.
- Suspicious ultrasound features of a thyroid nodule include microcalcification, a taller-than-wide shape, irregular margins and marked hypoechogenicity.
- Ultrasound with sialography or CT assesses the salivary glands, and a radio-opaque calculus in the submandibular duct is a common cause of obstruction.
- A lateral soft-tissue neck radiograph may show the thumb sign of acute epiglottitis or a retropharyngeal abscess with prevertebral soft-tissue widening.
- The steeple sign of subglottic narrowing on a frontal neck radiograph suggests croup in a young child.
- CT is the best modality to assess a cholesteatoma and the ossicular chain in chronic ear disease, showing bony erosion.
- A cervical rib and other bony neck anomalies are shown on plain radiographs of the thoracic inlet.
- Contrast-enhanced CT delineates deep neck space infections and abscesses and their spread along fascial planes.
- Nasopharyngeal and laryngeal tumours are staged with cross-sectional imaging to assess local extent and nodal spread.
- A foreign body in the aerodigestive tract may be shown on plain films if radio-opaque, with CT reserved for radiolucent or complicated cases.
Modality by ENT problem
- **Sinuses and temporal bone:** CT with bone windows for fine bony and air-space detail.
- **Head and neck masses:** MRI for soft-tissue extent and perineural tumour spread.
- **Thyroid and cervical nodes:** Ultrasound first line; guides fine-needle aspiration.
- **Airway emergencies:** Lateral neck radiograph: thumb sign in epiglottitis, steeple sign in croup.
NMC competencies in this chapter
- **RD1.3:** Radiological investigation and interpretation in common ENT disorders
Frequently Asked Questions
What is the best imaging for the paranasal sinuses?
CT with bone windows is the modality of choice. It shows mucosal thickening, air-fluid levels and opacification, and reveals bony erosion that would suggest invasive fungal disease or malignancy.
How is a thyroid nodule assessed?
Ultrasound is first line. Suspicious features include microcalcification, a taller-than-wide shape, irregular margins and marked hypoechogenicity, and ultrasound also guides fine-needle aspiration cytology.
What are the steeple and thumb signs?
The steeple sign is subglottic narrowing on a frontal neck radiograph in croup, and the thumb sign is a swollen epiglottis on a lateral radiograph in acute epiglottitis, both airway emergencies in children.
When is MRI preferred in head and neck imaging?
MRI is preferred for soft-tissue characterisation of masses, nasopharyngeal carcinoma and detecting perineural tumour spread, where its contrast resolution surpasses CT.
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