Radiography of the paranasal sinuses is performed in 2 projections: nasopharyngeal and chin. Each x-ray image allows visualization of specific anatomical structures.
Due to the many nuances and subtleties in laying, the appointment of the attending physician before performing an x-ray should be analyzed by a radiologist. The specialist may prescribe another projection or cancel the appointment of the attending physician.
What can be seen on the x-ray image of the paranasal sinuses (PNS) in the frontal projection
The paranasal sinuses in the frontal projection shows the following anatomical structures:
- Trellised labyrinth (picture after Reza).
- Right and left halves of the sphenoid sinuses.
Obviously, it is impossible to determine sinusitis with such an x-ray. This is true, therefore, the frontal projection is rarely used in the study of PPN pneumatization.
What does a radiograph of the PPN show in the chin projection
The chin projection in the study of sinusitis is the most preferred. She shows the sinuses as openly as possible. When using the naso-chin styling, the pyramids of the temporal bones are superimposed on the region of the maxillary sinuses in the lower third and prevent them from being clearly viewed throughout.
X-ray of the paranasal sinuses With poor-quality performance in the naso-chin projection, the pyramids of the temporal bones can almost completely block the view.
To level the above defect, the patient is often asked to open his mouth. With this laying, the temporal bones descend downward. The beam can also be directed vertically at an angle of 30 degrees to the vertical (according to Chebull). On such radiographs, the state of the sinuses of the sphenoid bones can be clearly traced.
If the projections described above are not enough, the PPN X-ray can be supplemented by tomographic examination or maxillary angiography. Tomography is a layered study. It allows you to study the anatomical structures that lie deep in the tissues.
Gymorography - the introduction of a contrast agent into the paranasal sinuses. The method is often used when a ring-shaped shadow resembling a cyst is detected.
How is the study of the paranasal sinuses
The study of the paranasal sinuses in the chin projection can be carried out in a vertical or horizontal (lying) position of the patient. Most often, during the procedure, a person sits or stands near a vertical x-ray stand. This laying allows you to get the best picture if you suspect sinusitis.
How is a PPN x-ray done?
- The patient stands along the rack with a fixed grid.
- His head is set so that the chin touches the bar, and the nose is at a distance of 2 cm from it.
- The median line of the head is located sagittally.
- The exposure is made on a cassette 13 by 18.
- Focal length - 100 cm.
An X-ray of the paranasal sinuses with a contrast agent allows you to fully study the structure of these anatomical formations and identify additional (“plus-shadows”) that can be formed by a cyst, polyps and tumors.
How to evaluate the quality of the picture in the study of the paranasal sinuses
A high-quality x-ray of the paranasal sinuses does not show additional shadows (artifacts). Anatomical structures are symmetrical and clearly visible.
With sinusitis, the fluid level is visualized, located from the medial to the lateral wall. Chronic inflammatory processes in PPN ( hypertrophic) are accompanied by a thickening of the mucous membrane with a concave outer contour (like a parabolic curve).
Scheme from the radiograph of the skull in the nasolabial projection To distinguish an acute process from a chronic one, it is advisable to shift the patient's head to the left or right during a second examination. If the inflammatory process is "fresh", the fluid level will shift.
With chronic changes, the x-ray symptoms of the pathology will not change.
Criteria for evaluating image quality:
- a clear structure of the bone walls;
- symmetry of laying;
- the presence of white-gray shadows (determines the technical features of the exposure).
Gaimorography - contrast study
Gymorography allows you to determine the intra-sinus formations. It is also used to diagnose polyps or cysts.
How is a hygroscopic examination performed?
- After anesthesia, the sinus wall is punctured.
- Through it, PPN are washed with a solution of furacilin.
- Then, using a needle, a solution of heated iodlipol is injected.
- The patient takes pictures in the nasolabial, naso-chin and lateral projections.
Attention! With genyantrography, it is impossible to take x-rays at the same time of both maxillary sinuses. In this situation, the possibility of a clear visualization of the anatomical structures due to overlapping exposure from the other sinus is excluded.
Radiography of the posterior nasal cavity
The posterior paranasal sinuses include the following anatomical structures:
- wedge-shaped;
- lattice cells.
For the study of these anatomical structures, the naso-chin and chin projections are not suitable. This is where axial projection comes into play. The rocky part of the temporal bone, foramina of the base of the skull, skull fractures can also be seen using this projection.
The sphenoid bone has a wide variety of structures. The radiologist must have a lot of experience to decipher correctly. On the x-ray in the axial projection of the rosary, the wings of the sphenoid bone, basilar apophyses are visible.
In this projection, holes are clearly visible: round, oval and ragged rear. With injuries of the skull (fall on the head, blows to the occipital bone and crown), a fracture line occurs. When viewed, the fracture lines and the lower jaw are visible, as well as the base of the apophysis of the occipital bone.
If a pathology is detected in one of these anatomical structures, the x-ray can be supplemented with pinpoint x-rays for clearer visualization.
In conclusion, I would like to say that the x-ray of the skull and paranasal sinuses is one of the most difficult areas of radiology. Due to the many formations, it is very common to see symptoms on the radiograph formed by the overlap and overlap of various anatomical details. A lot of practical experience is needed to distinguish the norm from the pathology in the images of the paranasal sinuses and skull.
Radiography, as a method of radiation diagnostics, is widely used in many areas of medicine, including otolaryngology. The study is carried out without damage to the upper tissues, that is, non-invasively, does not take much time, is painless.
X-ray of the nose and paranasal space allows you to reliably determine the existing changes in bone structures and the pathology of the air cavities (sinuses). A clear visualization of the organs on an x-ray image allows the doctor to objectively assess their condition, make the correct diagnosis, and prescribe the appropriate treatment. By decision of the ENT doctor, a survey or sighting radiography is performed:
- a survey x-ray, displays the bones of the nose and sinuses in general, and is more often performed during the initial diagnosis;
- sighting x-ray to consider individual anatomical structures in more detail. It is carried out to control the therapy of a previously diagnosed disease of a particular nasal area.
How often can this procedure be done? The frequency of the survey has not been officially established. The dose of x-rays in a single examination is not hazardous to health, but given that radiation tends to accumulate in the body, sinus x-rays are not recommended for more than twice a year.
Survey area
The picture is taken in black and white, which clearly shows the bone skeleton of the nose, the size of the nasopharynx, the structure and contours of the air cavities (otherwise the sinuses). According to the picture, the doctor analyzes the integrity of the bones and cartilaginous tissue, the state of the hollow formations adjacent to the nose:
- frontal (frontal) sinuses located in the frontal bone of the skull;
- lattice labyrinth;
- main sphenoidal sinus, divided by a septum;
- paired maxillary (maxillary) cavities;
- the lower part of the temporal bones with a cellular structure (mastoid process).
According to the norm, in the absence of pathologies, the outline of the bones should be even, the pneumatization (airiness) of the sinuses is not disturbed, that is, there are no neoplasms or liquid, foreign objects
Abnormalities and diseases diagnosed by the picture
One of the main diseases of the nasal cavities - sinusitis (inflammation of the mucous membranes), has several different forms. X-ray of the paranasal sinuses allows you to identify sinusitis. Sinus hyperplasia or hyperplastic sinusitis is characterized by increased growth of mucosal cells. In the picture, this area will have a thickening. Catarrhal, edematous-catarrhal or exudative (with accumulation of fluid) form of sinusitis is displayed on the radiograph as a sharp darkening of the inflamed sinus. Allergic sinusitis is manifested by severe swelling.
X-ray of the paranasal sinuses differentiates the disease at the location:
- inflammation of the maxillary sinuses - sinusitis;
- inflammation of the frontal sinus - frontal sinusitis;
- pathology of the mastoid processes - ethmoiditis.
The scale of the spread of the inflammatory process is also determined. With monosinusitis, the disease affects only one paranasal cavity, polysinusitis is diagnosed when inflammation is localized in several sinuses. If all right or all left sinuses are involved in the process, the diagnosis is hemisinusitis, the defeat of all cavities means the presence of pansinusitis.
Other pathologies
If the radiograph shows the presence of a round cavity with a clear outline in the sinus, this is a sign of a cyst. Rarely, other neoplasms are diagnosed. A foreign object that has fallen into the sinuses will also be displayed in the picture. Unevenly spaced, dark on x-ray, parietal areas indicate the presence of polyps (abnormal growths).
Photo x-ray of the nose with a diagnosis of polyposis specifies the localization of education
In children, using an X-ray examination of the nose and adjacent spaces, an inflammatory increase in the lymphatic tissue of the tissue of the nasopharyngeal tonsil - adenoiditis, as well as the degree of development of the disease, is diagnosed. With adenoids of the first degree, they occupy 1/3 of the nasopharyngeal lumen, the second degree is characterized by damage to ½ of the lumen, adenoids of the third degree completely block the lumen of the nasopharynx.
To diagnose tumors of benign and malignant origin, experts recommend undergoing an MRI or CT scan of the sinuses, since these methods are more informative in detecting such pathologies.
Diagnosis of cartilaginous and bone tissue of the nose
X-ray of the bones of the nose is always prescribed for bruises and other injuries. At the same time, the more quickly it is done after damage to the nose, the more reliable the results are. In the picture, the radiologist determines:
- possible normal fracture of the nose;
- fragmental fracture, and the presence of fragments in soft structures;
- fracture with displacement, and the degree of displacement of the bones.
The interpretation of the radiograph also involves the determination of the curvature of the nasal septum, any other transformations and destructive destruction of the bone and cartilage components of the organ.
Purpose of the survey
X-ray of the paranasal sinuses (PNS) is indicated for the following symptoms and complaints made by the patient:
- violation of the respiratory process due to chronic nasal congestion;
- the presence of pus and blood in the discharge;
- regular headaches, against the background of a runny nose, not associated with other diseases (hypertension, VVD, etc.);
- pain in the central frontal region when bending over;
- pain when touching the nose;
- post-traumatic pain and swelling of the bridge of the nose;
- suggestion of the presence of a foreign object in the nose.
These symptoms are most often accompanied by hyperthermia (fever), fatigue, a feeling of heaviness in the head. X-rays of the nose and adjacent cavities are done to control the therapy of previously diagnosed diseases: with sinusitis, sinusitis, frontal sinusitis, fracture and displacement of bones, polyposis and cysts. And also with specific diseases of the skeletal system of the body, such as osteomyelitis, osteoporosis.
The picture must be taken before the planned sinus surgery and after surgery
In some cases, the doctor may prescribe an additional computed tomography of the paranasal sinuses. Such a decision is made if the image does not reveal pathological changes, and there is no positive dynamics in the patient's condition, a neoplasm is visualized on the radiograph, but it is impossible to determine its nature, indications for surgery require a deeper study of the nasal region.
The CT scan takes longer and is more expensive, but the 3D image gives a clearer picture of the anatomical changes and disease present.
Contraindications
The examination is not prescribed during pregnancy, since X-rays have a teratogenic effect (violation of the development of the embryo). Relative (relative) contraindications are:
- metal-plastic dentures. Metal parts may affect the picture quality.
- childhood. The child is x-rayed only in case of emergency. At the same time, other parts of the body during the procedure must be protected by a special apron with lead content.
Safe MRI is recommended for diagnosis in young patients.
X-ray procedure
There are no preparatory measures for the examination. The patient only needs to choose where to make an x-ray: in a district clinic or a paid diagnostic center. Most often, the procedure is performed with the vertical position of the person being examined. Under the chin, a special stand is strengthened. It is the responsibility of the patient not to close his mouth during the procedure, and to hold his breath. The whole process takes half a minute.
For the diagnosis of bone damage, pictures are taken in direct projection and lateral (left and right). Additionally, a naso-chin projection can be taken. PPN are examined in the occipital-chin, direct, occipital-frontal, lateral and chin projections. Specifically, in which position the image will be taken depends on the diagnosis assumed by the otolaryngologist. The description of the image by a radiologist takes about a quarter of an hour.
genimorography
X-ray of the maxillary sinuses in the complicated course of sinusitis is performed using a contrast agent. Gymography is performed according to the doctor's prescription, and only for adult patients. The methodology includes:
- the use of local anesthesia;
- puncture of the sinus wall;
- washing the cavity;
- introduction of contrast into the studied sinuses;
- taking successive shots in several projections.
A photo from an x-ray of the paranasal sinuses with a diagnosis of sinusitis specifies the degree of filling of the sinus with contents
Removal of the contrast agent occurs spontaneously within 24 hours after the examination. Particular attention is paid to this disease and its diagnosis due to the risk of severe complications. Untimely detected sinusitis passes into the chronic stage, in which the development of inflammatory processes in the bronchopulmonary system and the brain is possible.
Digital x-ray
The digital radiographic method for studying PPN is more progressive and informative. The images of the nasal cavities are projected onto a computer, which allows a more detailed study of the changes and pathologies of the organ. In addition, it is possible to save the results in digital form, and transfer them, if necessary, via the Internet. The disadvantages of digital diagnostics include the cost of the examination.
For example, in the Moscow district of Brateevo, the price of such a procedure is from one and a half thousand rubles, as opposed to a conventional x-ray for 250 rubles. You should not be afraid of radiation exposure and ignore the prescribed x-ray procedure. The picture will help the doctor determine the only correct tactics for treating the identified disease.
Content
For the diagnosis of inflammatory processes in most cases, radiography of the paranasal sinuses is used. It is prescribed to identify various pathologies and inflammatory diseases that occur in this facial area. Learn about the features of this procedure and the problems it detects.
What is an x-ray of the paranasal sinuses
To detect the inflammatory process, radiography is often prescribed. An x-ray of the sinuses will help to detect a variety of dangerous diseases at the initial stage of development. This procedure is very simple, painless and does not take much time. Often this technique allows you to detect edema and fluid in the paranasal sinuses, the presence of neoplasms in them (cyst, tumor), flaws in the structure of the facial skeleton, damage, injuries of various kinds.
Indications for the appointment of the study
X-ray of the nose is an effective digital technique through which you can quickly obtain the necessary information about the pathology of the olfactory organ or paranasal cavities. Radiography is performed for the following indications:
- Regular nosebleeds that appear for no apparent reason.
- Closed or open trauma to the nasal bones or facial skull.
- Chance of sinusitis (with symptoms: rhinitis, headaches, high fever, difficulty breathing).
- Another prerequisite for x-rays of the sinuses is the suspicion of the presence of polyps, adenoids, cysts, tumors, foreign objects.
- Evaluation of the progress of the treatment process.
- Preparatory measures for surgical intervention.
Contraindications to the procedure
X-ray of the paranasal sinuses has several contraindications. It should not be done to pregnant women and children under the age of seven. The procedure is harmless and is characterized by low radiation exposure, but it is contraindicated for expectant mothers due to the strong sensitivity of the fetus to such a study. X-rays during pregnancy can cause birth defects in the baby.
For preschoolers, sinus x-rays may be extremely rare, because gamma rays can negatively affect the growth of the child's bones. In isolated cases, the doctor issues a referral for x-rays to children under 7 years of age and pregnant women (if the study becomes an alternative to the likely harm that the diagnosed disease can cause).
How often can x-rays of the sinuses be taken?
Many are interested in how often it is allowed to undergo an x-ray of the paranasal sinuses. After any examination performed with the help of gamma rays, the patient's outpatient card is supplemented with a record of the value of radiation exposure. If it turns out that these examinations were carried out too often, the doctor may prohibit a second procedure. There is a caveat: nasal radiography has a very low dosage of radiation, so this event is performed as many times as necessary to make a diagnosis.
How is the diagnosis carried out
X-ray of the maxillary sinuses is performed simply and quickly, without special training. Diagnosis is carried out on an outpatient basis. The patient must remove all metal products from himself. A person enters a special room where the study will be carried out. He needs to take a specific pose, which directly depends on the projection of the future image. As a rule, the procedure is performed in two projections: occipital-chin and occipital-frontal. X-ray of the nose is done while standing, holding the breath. The picture is developed, dried and studied.
Interpretation of indications
On the pictures taken after the diagnostic event, the doctor can detect various kinds of inflammation, tumors, foreign bodies in the sinuses, cysts, deviated nasal septum, developmental defects and the location of the injured facial bones. Even radiography can be used by doctors to diagnose sinusitis - an inflammatory process that affects the mucous membrane of the paranasal sinuses.
When the pathology is detected in the sinus of the upper jaw, then they make a diagnosis of sinusitis, other areas - ethmoiditis, frontal sinusitis, sphenoiditis. If pathology is detected in time, then there is a chance to avoid the development of serious complications (up to inflammation of the meninges). All modifications that the radiograph shows, the doctor makes a medical report, with which the patient is referred to the necessary specialist.
Where to do and how much does an x-ray of the nasal sinuses cost
Examination of the nose and its parts can be done in a public or private paid medical office in Moscow, St. Petersburg and other cities of the country. Below is the approximate price of an X-ray examination, which depends on the specific clinic:
- X-ray of the paranasal sinuses (one projection) - from 1300 rubles.
- X-ray of the nasal sinuses (2 projections) - from 1700 rubles.
X-ray of the paranasal sinuses- radiographic method of examination of the paranasal sinuses. An x-ray of the sinuses allows you to assess the presence of inflammation, fluid, as well as fractures, displacement of the bones of the nose.
In what cases is required. X-ray of the paranasal sinuses is performed to diagnose the presence of foreign bodies, cysts, tumors, wounded bones, stunted teeth, fractures of the bones of the face, absence and underdevelopment of the sinuses, inflammation of the paranasal sinuses.
Procedure. X-ray of the nose does not require special preparation. Contraindications: pregnancy, lactation, open pneumothorax, pulmonary bleeding. When performing an x-ray, the patient leans on his chin, during the picture it is necessary to keep his mouth open.
Price. The average cost of an x-ray of the paranasal sinuses: 1200 rubles.
Questions and answers:
Where to make an x-ray of the paranasal sinuses in Moscow?
The DocDoc.ru website contains the best clinics in Moscow that perform diagnostic x-rays of the paranasal sinuses. Choose a center for this procedure right on our website according to important criteria for you: location of the center, price, work schedule.
How much does an x-ray of the paranasal sinuses cost?
Prices for x-rays of the paranasal sinuses depend on many factors, primarily on the quality of the equipment and the location of the diagnostic center. On DocDoc.ru you will find the best centers in Moscow, which you can sort by the cost of the procedure. The questionnaire of each center contains information about its work schedule, as well as a telephone number by which you can immediately sign up for the study.
Found 218 clinics where you can get x-rays of the paranasal sinuses in Moscow.
How much does a PPN x-ray cost in Moscow
Prices for x-rays of the paranasal sinuses in Moscow from 800 rubles. up to 11731 rubles..
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What is the essence of the study?
X-rays of the paranasal sinuses are made in patients with obvious pathology of the nose to exclude or identify concomitant diseases of the paranasal sinuses - sinusitis. The sinuses or sinuses are paired air-filled pockets that surround the nose. The functions of the sinuses include humidifying the air inhaled through the nose, insulating the brain, and giving tone to voice production.
There are four pairs of sinuses:
- Frontal sinuses, located near the center of your forehead just above each eye.
- The maxillary sinuses are located behind the cheekbones, near the upper jaw.
- Sphenoid sinuses, near the optic nerves and the pituitary gland.
- Ethmoid sinuses - between the eyes and the bridge of the nose.
Normally, the sinuses are filled with air, which is why healthy sinuses will look black on x-rays. A gray or white area on an X-ray indicates a problem with inflammation or fluid in the sinuses, such as sinusitis.
What does it show? What diseases does it diagnose?
X-rays are ordered if symptoms of a sinus infection are likely. Sinusitis occurs when the sinuses become inflamed and filled with pus and mucus. Acute sinusitis is caused by viral, fungal, and bacterial infections.
Sinusitis symptoms include:
- stuffy nose with thick discharge
- pain or heaviness in the forehead, between the eyes, in the cheekbones or upper jaw,
- swelling around the eyes, nose, or cheeks
- decreased sense of smell
- cough, sore throat, earache,
- fever.
Sinus problems can also be caused by:
- allergies
- tumors or polyps in the nasal passages or sinuses,
- enlarged adenoids,
- injuries
- infections in other areas of the head,
- deviated nasal septum.
How is the research done?
Sinus X-rays can be performed on an outpatient basis or during hospitalization in the ENT department. The patient is placed or seated on the x-ray table. The radiologist then covers the subject's body with a lead apron to protect from radiation. The head is placed under the x-ray tube. The radiologist will then go into the next room to take a picture. During the x-ray, you must remain as still as possible. Otherwise, the image will be blurry. It only takes a couple of seconds to complete an x-ray image. You may hear a click similar to the sound the camera makes when taking a picture. The doctor may change the position of the patient several times to obtain images of all the sinuses. Typically, images are taken in three projections: lateral view, occipitofrontal and axial view.
Contraindications and restrictions
Pregnant women are not allowed to take x-rays.
Study preparation
X-ray examination does not require special preparation. Women must be sure that they are not pregnant. It is necessary to remove jewelry, removable metal dentures, hairpins, earrings and glasses.
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