This page contains OSCE notes in various radiological images pertaining to rhinology.
Station 1:
1. What view is this CT scan ?
2. Describe the lesion seen.
3. What could be the lesion ?
This is a CT scan of paranasal sinuses plain coronal view.
It shows an expanding soft tissue lesion involving the right nose, right maxillary sinus.
The medial wall of right maxillary sinus is found eroded. The nasal septum is
pushed completely to the left side. The medial and inferior orbital walls are also
involved. The mass has breached into the orbit. The skull base area appears free.
Possible diagnosis : Malignant tumor right nose and maxilla involving the orbit.
Station 2:
Name any 4 risk factors for sinonasal cancers.
1. Exposure to hard wood dust - (African Mahogany could cause adenocarcinoma)
2. Exposure to soft wood dust - could cause squamous cell carcinoma
3. Exposure to nickel - squamous cell carcinoma
4. Exposure to volatile hydrocarbons - squamous cell carcinoma
Station 3:
Name 4 ocular features of sinonasal malignancy.
1. Unilateral tearing
2. Diplopia
3. Exophthalmos
4. Orbital pain
Station 4:
50 years old male patient came with c/o
1. Foul smelling discharge from right nose - 1 year
2. Bleeding from right nose - 1 year
3. Whitish mass seen inside the right nasal cavity - gritty on touch.
4. X-ray of the patient is shown
comment.
This is x-ray paranasal sinuses water's view. This shows a dense radio opaque
shadow occupying the floor of the right nasal cavity.
Possible diagnosis:
1. Rhinolith
2. Foreign body nose
Station 5:
Comment on the CT scan.
This is a coronal CT scan plain of paranasal sinuses.
It shows a huge concha bullosa. The whole right nasal cavity
is filled with concha. The concha even prolapses into the right
maxillary sinus cavity reducing its size. The right frontal sinus
drains into the concha. Bulla is seen in the medial wall of the orbit.
Station 6:
Name the numbered structures.
1 - Lamina papyracea
3 - Right middle turbinate
4 - Right maxillary sinus
2 - Concha bullosa of left middle turbinate
Station 7:
10 years old child came with c/o nasal block both sides since birth.
Dryness of mouth since birth.
Foul smelling nasal discharge both sides.
CT scan picture showed:
What is the view ?
What could be the probable diagnosis ?
Contrast CT of paranasal sinuses axial cut. Contrast material is instilled into both nasal cavities.
Shows that the contrast material does not flow into the nasopharynx.
The choana is closed by bony plates on both sides.
Diagnosis: Bilateral choanal atresia.
Station 8:
Patient came with c/o double vision and swelling over right eye - 1 day duration.
H/O punched injury to right orbit ++
H/O bleeding from right nose ++
CT scan showed:
Comment on the scan.
What test you perform to rule out inferior rectus entrapment ?
CT scan shows blow out fracture of right orbit.
Forced duction test is performed to rule out entrapment of inferior oblique muscle
Station 9:
Comment on the MRI & CT
Axial MRI showing mass involving the nose, involving the optic nerve.
The mass appears bright in T2 weighted image.
Axial CT image showing heterodense lesion filling the left nasal cavity.
Left lamina papyracea appears breached.
Probable diagnosis: Fungal sinusitis with orbital complication
Station 10
Read the CT scan
This is CT scan plain coronal view.
Heterodense mass seen occupying the left maxillary sinus eroding the medial wall of maxilla and protruding into the nasal cavity.
Anterolateral wall of maxilla appears intact
Lamina papyracea appears breached. Mass could be seen entering the orbit.
Nasal septum could be seen pushed to the right side
Possible diagnosis:
1. Fungal sinusitis.
This is considered due to the fact that the mass appears heterodense, the anterolateral wall of the
maxilla appear intact.
2. Malignant tumor of maxillary sinus (left)
Station 11
This is a CT scan of a 50 years old male patient who presented with blindness of right eye of 3 days duration.
He also gave history of head ace - 1 month duration.
He was a known diabetic on treatment for 10 years.
comment on the CT scan.
This is an axial scan showing enlarged sphenoid sinus on the right side.
The right sphenoid sinus appears hazy and heterodense and the enlarged sphenoid sinus abuts the optic nerve on the right side.
Probable diagnosis Sphenoidal sinusitis right side. Probably fungal in nature.
Station 12
Comment on this CT especially pertaining to 1 and 2.
1 - Bulla showing mucosal thickening
2 - Concha bullosa showing mucosal thickening
Impression: Anterior ethmoiditis
Station 13
35 years old female patient came with c/o watery discharge from left nasal cavity - 3 years
H/O fever with rigor on and off - 1 year
Head ache on and off - 1 year
You are seeing a coronal ct scan picture of the patient.
Comment on the ct.
How to manage this patient?
Coronal ct shows defect in the cribriform fossa on the left side.
The patient is having csf rhinorrhoea.
Prophylactic antibiotic therapy and closure of csf leak is the ideal managment modality.
Station 14
15 year old boy presented with bleeding from right nose - 1 month
Swelling just below the medial canthus of right eye - 15 days
Anterior rhinoscopy showed reddish friable mass occupying the right inferior meatus.
CT scan coronal cut showed:
Comment on the CT scan.
This is a coronal CT scan of nose and paranasal sinuses (anterior cut).
Soft tissue shadow could be seen medial to the medial wall of right orbit.
Lamina papyracea intact. The same soft tissue shadow could be seen
extending along the nasolacrimal duct up to the inferior meatus.
Possible diagnosis: Nasolacrimal rhinosporidiosis
Station 15
Comment on the xray paranasal sinuses water's view.
What could be the probable diagnosis?
Can you comment on the status of pterygopalatine fossa from this xray?
.JPG)
This is a digital plain x-ray paranasal sinuses water's view.
It shows an expansile lesion involving right maxilla. Lateral wall of maxilla is found to be eroded.
The floor of the orbit (R) is also eroded with extension of mass into right orbit.
Probable diagnosis could be Malignant growth right maxilla.
Since the patient has kept his mouth open during xray, there is no trismus and hence pterygopalatine fossa
may not have been involved.
Station 16
Comment on the CT scan shown below:
This is an image of Coronal CT plain of paranasal sinus. Posterior cut is demonstrated.
Heterodense mass could be seen arising from right maxillary sinus. Medial wall of the right
maxillary sinus eroded. The same mass could be seen filling the right nasal cavity. Hard palate
on the right side is eroded.
Probable diagnosis:
1. Fungal infection of maxillary sinus with erosion
2. Malignant lesion of maxillary sinus
Station 17
Comment on the CT scan shown below:
This is a coronal CT scan plain of Nose and paranasal sinuses.
It shows thinned nasal mucosal lining.
The turbinates appear to be atrophic.
The nasal cavities appear to be excessively roomy on both sides.
Probable diagnosis - Atrophic rhinitis