imagenes en orl
TRANSCRIPT
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HOSPITAL NAC. A. POSADASHOSPITAL NAC. A. POSADASSERVICIO DE ORLSERVICIO DE ORL
DRA CECILIA KIMDRA CECILIA KIM
SEPT.2008SEPT.2008
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IMAGENES EN IMAGENES EN ORLORL
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IMÁGENES EN ORLIMÁGENES EN ORL
RADIOGRAFIA SIMPLERADIOGRAFIA SIMPLE
TOMOGRAFIA AXIAL TOMOGRAFIA AXIAL COMPUTARIZADACOMPUTARIZADA
RESONANCIA MAGNETICA RESONANCIA MAGNETICA NUCLEARNUCLEAR
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TAC – RMNTAC – RMN
Estudios de imágenes mas Estudios de imágenes mas ampliamente utilizados para evaluar ampliamente utilizados para evaluar patologias de cabeza y cuello.patologias de cabeza y cuello.
A menudo se requiere la A menudo se requiere la combinacion de ambos para combinacion de ambos para comprender el tipo y extension de la comprender el tipo y extension de la patologia.patologia.
Rx convencional es limitado como Rx convencional es limitado como metodo de diagnosticometodo de diagnostico
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TACTAC RMNRMN
Partes oseasPartes oseas Partes blandasPartes blandas
Radiacion ionizanteRadiacion ionizante Campo magneticoCampo magnetico
Menos costosaMenos costosa Mas costosaMas costosa
Mejor para distinguir Mejor para distinguir extension perineuralextension perineural
Mejor para distinguir Mejor para distinguir tejido solido (ej tejido solido (ej tumor) de las tumor) de las secresiones proteicas secresiones proteicas (ej.sinusitis cronica)(ej.sinusitis cronica)
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QUE BUSCAR EN LAS QUE BUSCAR EN LAS IMAGENESIMAGENES
Naturaleza y extensión patológicaNaturaleza y extensión patológica
Variación anatómica (patológica oVariación anatómica (patológica ovariante) ante un tto quirúrgicovariante) ante un tto quirúrgico
Posibles complicacionesPosibles complicaciones
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OIDOOIDO
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RX SIMPLERX SIMPLE
SCHULLERSCHULLER CHAUSSE IIICHAUSSE III TRANSORBITARIA BILATERAL TRANSORBITARIA BILATERAL
COMPARATIVACOMPARATIVA STENVERSSTENVERS
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TACTAC
TAC DE AMBOS HUESOS TEMPORALESTAC DE AMBOS HUESOS TEMPORALES (con ventana osea) AXIAL Y CORONAL(con ventana osea) AXIAL Y CORONAL Con o Sin contraste Con o Sin contraste
Reconstruccion sagitalReconstruccion sagital Reconstruccion 3DReconstruccion 3D
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Permite evaluarPermite evaluar Limites oseos y dehiscenciasLimites oseos y dehiscencias Neumatizacion de mastoides Neumatizacion de mastoides
(neumatizadas, diploicas, eburneas)(neumatizadas, diploicas, eburneas) CAI / CAECAI / CAE Laberinto oseo (oido interno)Laberinto oseo (oido interno) Cadena osicular Cadena osicular VII 1º 2º 3º porcionVII 1º 2º 3º porcion Relacion con las estructuras vasculares Relacion con las estructuras vasculares
cercanascercanas(seno lateral, golfo de la yugular, carotida (seno lateral, golfo de la yugular, carotida intena)intena)
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INDICACIONESINDICACIONES
Previo a cirugia otologicaPrevio a cirugia otologica Otitis medias cronicas (ej. Otitis medias cronicas (ej.
colesteatomatosa)colesteatomatosa) TraumatismosTraumatismos NeoplasiasNeoplasias Malformaciones auditivasMalformaciones auditivas Osteodistrofias Osteodistrofias
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OMC atelectasiaOMC atelectasia
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OMCOMC
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OMC colesteatomatosaOMC colesteatomatosa
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Fractura de peñasco
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Ca de CAE
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Otoesclerosis Otoesclerosis
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RMNRMN
RMN DE CAI Y APCRMN DE CAI Y APC Con y/o sin gadolinioCon y/o sin gadolinio
De eleccion para:De eleccion para: patologias tumorales intracanaliculares en el patologias tumorales intracanaliculares en el
CAI y APCCAI y APC Patologias vasculares (angio RMN)Patologias vasculares (angio RMN) Lesiones desmielinizantesLesiones desmielinizantes
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RMNRMN
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T1T1 T2T2
AGUA AGUA
(LCR)(LCR)NEGRO (HIPO)NEGRO (HIPO) BLANCO BLANCO
(HIPER)(HIPER)
GRASAGRASA BLANCABLANCA GRISGRIS
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Schwanoma del VIIISchwanoma del VIII
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Meningioma Meningioma
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Laberintitis osificanteLaberintitis osificante
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NARIZ Y SPNNARIZ Y SPN
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Senos paranasales: Desarrollo
Seno Maxilar: al nacimiento. visible 2 o 3 meses Celdillas etmoidales: al nacimiento: visibles 3 – 6 meses tamaño adulto a los 10 – 12 años Seno esfenoidal: 1 a 2 años Senos frontales: 8 a10 años tamaño adulto a los 14 años
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RX SIMPLERX SIMPLE
RX CAVUM PERFIL RX CAVUM PERFIL FNP / CALDWELLFNP / CALDWELL MNP / WATERSMNP / WATERS LATERAL DE CRANEOLATERAL DE CRANEO SUBMENTOVERTEXPLACASUBMENTOVERTEXPLACA PERFIL DE HUESOS PROPIOSPERFIL DE HUESOS PROPIOS
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CAVUMCAVUM
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RX CAVUMRX CAVUM
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GRADOS DE V.A.GRADOS DE V.A.
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MNPMNP
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La piramide del peLa piramide del peñasco debe ñasco debe proyectarse justo por debajo del piso proyectarse justo por debajo del piso del seno maxilardel seno maxilar
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FNPFNP
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La piramide del peñasco debe La piramide del peñasco debe proyectarse en el tercio inferior de proyectarse en el tercio inferior de la orbitala orbita
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RX LATERAL DE RX LATERAL DE CRANEOCRANEO
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SUBMENTOVERTEXPLASUBMENTOVERTEXPLACACA
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Rx huesos propios de la Rx huesos propios de la nariznariz
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TAC TAC
TAC DE MACIZO CRANEOFACIALTAC DE MACIZO CRANEOFACIALAXIAL – CORONALAXIAL – CORONAL
Con o sin cteCon o sin cte
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INDICACIONESINDICACIONES
Sinusitis cronicaSinusitis cronica Sinusitis aguda complicadaSinusitis aguda complicada TraumatismosTraumatismos NeoplasiasNeoplasias Insuficiencia ventilatoria nasal Insuficiencia ventilatoria nasal
(desviacion septal, apnea de sueño, (desviacion septal, apnea de sueño, etc)etc)
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Sinusitis maxilarSinusitis maxilar
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Etmoiditis Etmoiditis
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Quiste de retencionQuiste de retencion
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Sinusitis fungicaSinusitis fungica
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Cornete medio bullosoCornete medio bulloso
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Atresia de coanasAtresia de coanas
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Fisura palatinaFisura palatina
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Mucocele esfenoidal t2Mucocele esfenoidal t2
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Papiloma invertidoPapiloma invertido
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Osteoma Osteoma
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Fracturas Fracturas
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Fracturas Fracturas
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RMNRMN
RMN DE MCF RMN DE MCF AXIAL-CORONAL-SAGITALAXIAL-CORONAL-SAGITAL
Con o Sin gadolinioCon o Sin gadolinio
INDICACIONESINDICACIONES Para distinguir tejido solido (ej tumor) de Para distinguir tejido solido (ej tumor) de
las secresiones proteicas (ej.sinusitis las secresiones proteicas (ej.sinusitis cronica)cronica)
Tumores Tumores
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sinusitissinusitis
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Tumor vs SecrecionTumor vs Secrecion
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Sinusitis t2Sinusitis t2
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Sinusitis t2Sinusitis t2
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Encefalocele t2Encefalocele t2
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Ca escamoso t1Ca escamoso t1
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Fibroangioma nasofaringeo Fibroangioma nasofaringeo juveniljuvenil
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CUELLOCUELLO
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RX PERFIL DE CUELLO RX PERFIL DE CUELLO PARA PARTES BLANDASPARA PARTES BLANDAS
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Cuerpo extraCuerpo extrañoño
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Edema supraglotis
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TAC DE CUELLO TAC DE CUELLO AXIAL – CORONAL AXIAL – CORONAL
CON O SIN CTECON O SIN CTE
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