RADIOLOGA DE LA VA AREA

ANA MILENA SNCHEZ PARRA

Anestesiologa y Reanimacin Universidad de Antioquia Medelln Colombia

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Indicaciones
Politraumatismo Enfermedades

degenerativas Malformaciones M lf i congnitas it Carcinomas Alteracin de la ATM Disfuncin Columna Cervical

Evaluacin Radiolgica
Seguridad

para la intubacin. Habilidad de la apertura oral. Obstruccin de la VA Desplazamiento de la via area Evaluar extensin y profundidad de la lesin. Linfadenopatas. Linfadenopatas Relacin masa grandes vasos.

Estudios imagenolgicos
Tomografia

axial : ms til

Radiografas. R di f Resonancia

Magntica Nuclear

ANATOMA

Espacio p Parafarngeo g (PPS) ( ) Espacio Mucosa Faringea (PMS) Espacio Parotdeo (PS) E Espacio i Carotideo C id (CS) Espacio Masticador (MS) Espacio Retrofaringeo (RPS) Espacio Prevertebral (PVS) Cavidad oral (OC) Espacio Sublingual (SLS) Espacio Submandibular (SMS)

Anatomia Normal .

NASOFARINGE:

linfoide Base B d del l crneo hasta h t el l paladar l d blando bl d

mucosa respiratoria y tejido

E. PARAFARINGEO: Base del craneo a fascia gland submandibular Grasa y vasos sanguineos. g Nervios Glandulas Salivares menores

Anatomia Normal
FOSA OS

INFRATEMPORAL

Lobulo profundo g.parotidas. id Rama del maxilar. M Musculos l pterigoideos. t i id Musculo temporal. Ramas de la arteria max.interna y V3 Grasa Linfaticos.

Anatomia Normal
PAQUETE

VN (CAROTIDEO)
Arteria Cartida interna. Vena y yugular g interna. Nervios Craneales: IX , X , XII Cadenas simpticas.

Anatomia Normal
CAVIDAD

ORAL

Lengua y piso de la boca. B Base d de l la lengua. l Orofaringe. Amgdalas Trigono retromolar Espacio submandibular

COMPARTIMIENTOS CABEZA Y CUELLO

COMPARTIMIENTO

SUPRAHIODEO.

Espacio Submandibular Espacio E i Parafarngeo. P f

COMPARTIMIENTO

INFRAHIODEO.

Espacio pretraqueal: pretraqueal:Desde Desde el hioides al mediastino anterior, , rodea la trquea. q Espacio retrofarngeo, danger space y espacio vascular

Espacio Suprahiodeo:CT
Evaluar

tumores derivados de mucosas. Relacion R l i de d la l masa anatomia t i . Cortes 33-5mm, medios de contraste. Coronales:Lengua, piso de la boca , g retromolar, , mandibula. trigono

 Carcinoma

de cells escamosas. Medio de contraste y cortes de 1mm Pruebas funcionales : m. valsalva Ventanas oseas: trauma Cortes C t coronales l :optimizan ti i la l visin i i de d la l glotis.
Tiroides

Laringe y cuello infrahiodeo:CT i f hi d CT

y paratiroides.

m. digastrico(d), m.geniogloso (g), m.genihiodeo (gh), m.pterigoideo lat (lp), m.masetero(m), m.pterigoideo medio (mp),espacio masticador (MS),m.milohiodeo (*), e.nasofaringeo (PMS, small arrows), e.parotideo (PS), rama mandibular (r) e. sublingual (SL), e.submandibular (SM), paladar suave (sp), m.intrinseca lengua

internal carotid (c), epiglottis (e), genioglossus muscle (g), jugular v (J), lingual tonsil (l), medial pterygoid muscle (mp), masticator space (MS), mylohyoid muscle (asterisk), pharyngeal p y g mucosal space p of oropharynx p y ( (small arrows) ), prevertebral p space p (PVS) ( ), retropharyngeal space (arrowheads), sublingual space (SL), submandibular space (SM), submandibular gland (smg), intrinsic musculature of tongue (T), masseter muscle (m),

Absceso amigdalas. amigdalas TAC demuestra lesion de baja densidad(arrowheads) con anillo periferico. La amigdala izq. Esta aumentada El e.parafaringeo (arrow) esta lateral.

A, hiodes; B, cuerdas falsas; C, c.vocales;D tiroides. arytenoid cartilage (a), e. cervical anterior (AC), pliegues ariepigloticos (ae), m.escaleno anterior(asm), plexo brachial (b), a.carotida (c), C.cricoide (cc), epiglotis(e), esofago(es), hyoides(h), v.yugular(J),e. cervical posterior (PC), grasa preepiglotica(pe), g.paralaringea (pl), e.prevertebral (PVS),e .faringeo (small arrows), m.platisma (large arrow), e.retrofaringeo(arrowheads),e.sup.cervical(SC), m.esternocleidomastoide(scm), g.submandibular (smg), c.tiroideo(tc), tiroides(tg), traquea (tr), cuerdas vocales(tvc).

TC con contraste laringe supragloctica . A, las dos valleculas llenas de aire(V) separadas por el pliegue glosoepiglotico medio anterior a la epiglotis(arrows).v.yugular (j), a.carotida interna (i),arteria carotida externa (e), m.esternocleidomastoideo (s), hiodes (H) B, 8 mm inferiores,grasa preepiglotica (PES) contrasta anteriormente con la densidad de epiglotis (arrow).la g. preepiglotica extiende posterolateralmente en el e. paralaringeo(paraglottic) (PLS). Lo pliegues ariepiglotiocs(arrowheads) separan los senos piriformes(P) y el Vestibulo laryngeo (Ve).

RMN:SUPRAGLOTIS

CV Falsas (arrows), mediales a la gr. paraglotica proximas a los cartilagos aritenoides (f) El nodo tiroideo (arrowhead) esta anterior entre Las laminas del tiroides. El cartilago tiroides no calcificado, Vena yugular (J) y arteria carotida

CV verdaderas d d ( hi arrow) (white ) a nivel i ld de l los Procesos vocales de los aritenoides(arrowhead) (A), localizados superolateralalmente al borde posterior del cartilago cricoide(Cr).los tejidos blandos en la commisura anterior (black arrow) Mide normalmente menos de 2 mm

Infrahyoid retropharyngeal space and visceral space abscess. A, TC at level of false vocal cords demonstrates low-density abscess in retropharyngeal space (arrowheads) creating a bow bow-tie tie configuration configuration. The abscess extends laterally to the left posterior cervical space and anteriorly into the visceral and anterior cervical spaces. B, Communication between retropharyngeal space and mediastinum is well y cephalad p extension of this mediastinal abscess ( (asterisk) )p posterior demonstrated by to the trachea.

Transglottic laryngeal squamous cell carcinoma with vocal cord fixation. A, True vocal cords are adducted on axial contrast-enhanced computed tomography obtained during breath holding holding, with tumor extending anteriorly and superiorly from the left true cord into adjacent paralaryngeal fat (arrow) and posteriorly into cricoarytenoid joint (arrowheads). Anterior corner of calcified left arytenoid cartilage (asterisk) has been eroded by the tumor. B, Repeat axial CECT, performed during quiet i tb breathing, thi reveals l fi fixation ti of f th the l left ft t true cord di in midline; idli right i ht cord di is partially ti ll abducted.

Transglottic squamous cell carcinoma with cartilage invasion. Axial CECT at the true vocal l cord dl level l shows h enhancing h i mass (m) ( ) originating i i ti i in th the l left ft vocal l cord, d crossing i anterior commissure, and invading anterior third of the right cord. The tumor has invaded through anterior thyroid cartilage and displaces thyroid strap muscles anteriorly (arrowheads) ( ).

Extrinsic tracheal compression. A, Computed tomography scan shows large mediastinal mass (M), secondary to oat cell carcinoma, compressing trachea (T) and superior vena cava (arrow). B, In another patient with lymphoma, magnetic resonance imaging shows extrinsic compression of the carina (arrows) by large mass (M).

COLUMNA CERVICAL

Evaluacin Radiogrfica.
Alineacin

y anatoma Integridad d d sea Cartlago o espacio articular Partes Blandas

Alteraciones C. Cervical
Interrupcion

de las lineas de CV Ant y post Desplazamiento:alineacion l.espinolaminar Ensanchamiento E h i t espacio i interpedicular. i t di l Rotacion apofisis espinosas Curvatura anormal Anomalias integridad osea: corticales

Retropharyngeal abscess secondary to foreign body perforation of the esophagus The prevertebral soft tissues are markedly swollen, and the trachea is displaced anteriorly (small arrows). Large arrow points to a metallic foreign body

Marked thickening of the epiglottis (arrow) and aryepiglottic folds (arrowheads) is seen. Mild hypopharyngeal overdistention is also present.

Collegiate football defensive back sustained axial loading injury to p while making g tackle; ; cervical spine he was rendered a complete C5 quadriplegic A, Lateral roentgenogram shows mild anterior subluxation of C4 and C5 caused by left unilateral facet dislocation. B, CT scan with coronal reconstruction shows significant g fractures of bodies of C5 and C6 that were not noted on lateral roentgenogram. C, CT scan
through C4 vertebral body shows fractures through ipsilateral right pedicle and lamina with free-floating lateral mass at this level. D, CT scan through C4 and C5 shows unilateral il ll left-sided f id d C4 C4-5 facet f dislocation di l i (arrow). ( ) E, E CT scan with ih sagittal reconstruction shows left-sided unilateral C4-5 facet dislocation. F, CT scan through C5 vertebral body shows significant fractures of anterior and posterior elements and marked narrowing of spinal canal canal. G, G CT scan with sagittal reconstruction shows significant narrowing of spinal canal resulting from retropulsed bone and disc material. H, CT scan with contrast in subarachnoid space shows disc material retropulsed into spinal canal to left of midline behind body of C4.

GRACIAS

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