Sinonasal CT

WHAT IS YOUR DIAGNOSIS?

A. Avner BSc BVSc CVR MRCVS DVDI

Case Study: Sinonasal CT

Signalment:
An eight year-old, male intact pug was referred to the Knowledge Farm Referral Centre, Beit Berl for nasal CT. The dog was presented with the complaint of intermittent sneezing, gagging and infrequent unilateral nasal discharge and epistaxis of two to three weeks duration.
At the referring vet the dog was given a course of broad spectrum antibiotics and a nasal flush was performed. No favorable clinical response followed.
On clinical examination the dog appeared alert and had good body condition. Investigation of the head reviled remnant of serosanguineous discharge and reduced air flow through the L nasal orifice.
Neurological examination was unremarkable. There was no evidence of head and neck lymph node enlargement.
The dog was anaesthetized using induction with Propofol, intubated and maintained on inhalation anesthesia of Isofluran.
It was positioned in sternal recumbency (head in, face down- with relation to the CT gantry).
Helical CT examination of the sinonasal cavities was performed pre and post iv contrast administration (2ml/kg Omnipaque).
After image acquisition sagittal and dorsal reconstruction images were acquired in order to image the sinonasal cavities in various planes.
The following images were selected:


fig. 1

Fig. 1: Transverse image (post iv contrast) of the nasal cavities at the level of PM1.

fig. 2


Fig. 2:  Sagittal and dorsal reconstruction images (post iv contrast) through the L nasal cavity.


Questions:
1. What abnormalities are present on the CT images?
2. What are the differential diagnoses?
3. Are the reconstruction images advantageous? Explain.
4. How would you manage this case?

 

 

 

 

 

 

 

 

For The clinical investigation findings and final results press here.