False Computed Tomography Findings in Bilateral Choanal Atresia
08 April 2015
04 October 2015
15 December 2015 (online)
Introduction Choanal atresia (CA) is a challenging surgical problem defined as a failure in the development of communication between the nasal cavity and nasopharynx.
Objective The objective of this study is to describe computed tomography (CT) findings in cases with bilateral choanal atresia.
Methods The study involved performing axial and coronal non-contrast CT scanning with 2–3 mm sections on14 neonates that had bilateral CA. We used fiberoptic nasal endoscopy to confirm the diagnosis. We evaluated coronal CT to study the skull base area in such neonates.
Results This study included 14 neonates with bilateral CA; with mean age of 7 ± 3.5 days. Mixed atretic plates were found in 12 (85.7%) cases while two (14.3%) had pure bony atresia. Isolated CA was detected in 9 cases (64.3%) and 5 (35.7%) cases had associated anomalies. Coronal CT showed soft tissue density in the nasal cavity that appeared to extend through an apparent defect in the nasal roof (cribriform plate), falsely diagnosed by radiologists as associated encephalocele. At the time of surgical repair, all patients showed thick tenacious mucous secretions in both nasal cavities and revealed no encephalocele. Nasal roof remained intact in all cases.
Conclusion The thick secretion of bilateral CA could give a false encephalocele appearance on the CT. It is highly recommended to perform proper suction of the nasal cavity of suspected CA cases just before CT scanning.
- 1 Ibrahim AA, Magdy EA, Hassab MH. Endoscopic choanoplasty without stenting for congenital choanal atresia repair. Int J Pediatr Otorhinolaryngol 2010; 74 (2) 144-150
- 2 Gujrathi CS, Daniel SJ, James AL, Forte V. Management of bilateral choanal atresia in the neonate: an institutional review. Int J Pediatr Otorhinolaryngol 2004; 68 (4) 399-407
- 3 Case AP, Mitchell LE. Prevalence and patterns of choanal atresia and choanal stenosis among pregnancies in Texas, 1999-2004. Am J Med Genet A 2011; 155A (4) 786-791
- 4 Lubianca Neto JF, Kuhl G, Smith MM, Souza PA, Vieira LR. Association between congenital nasolacrimal duct cyst and bilateral choanal atresia. Braz J Otorhinolaryngol 2011; 77 (2) 267
- 5 Keller JL, Kacker A. Choanal atresia, CHARGE association, and congenital nasal stenosis. Otolaryngol Clin North Am 2000; 33 (6) 1343-1351 , viii
- 6 Schoem SR. Transnasal endoscopic repair of choanal atresia: why stent?. Otolaryngol Head Neck Surg 2004; 131 (4) 362-366
- 7 Elsheikh E, El-Anwar MW, Abdel-aziz HR, Mohamed AF, Annany A. Choanal atresia: histochemical, immunohistochemical and ultrastructure study of the nasal mucosa. Int J Pediatr Otorhinolaryngol 2015; 79 (2) 170-174
- 8 Naidich TP, Osborn RE, Bauer BS, Mclone DG, Kernahan DA, Zaparackas ZG. Embryology and congenital lesions of the midface. In: Som PM, Bergerson RT, Curtin HD, , et al, eds. Head and Neck Imaging. 2nd ed. St Louis, Mo: Mosby-Year Book; 1991: 7-26
- 9 Naidich TP, Takahashi S, Tobin RB. Normal patterns of ossification of the skull base: ages 0–16 years. Presented at the annual meeting of the Radiological Society of North America, Chicago, Ill, November 1985
- 10 Sattar A, Sultan T. Choanal atresia, review article. Bangladesh J Otorhinolaryngol 2011; 17 (1) 59-61
- 11 Naidich TP, Altman NR, Braffman BH, McLone DG, Zimmerman RA. Cephaloceles and related malformations. AJNR Am J Neuroradiol 1992; 13 (2) 655-690
- 12 Chaudhary V, Anand RMK, Narula MK, Singh SK. The role of computed tomography in the evaluation of bilateral choanal atresia: two case reports. Iran J Radiol 2009; 6 (4) 221-224
- 13 Scott JH. The cartilage of the nasal septum (a contribution to the study of facial growth). Br Dent J 1953; 95: 37-43
- 14 Black CM, Dungan D, Fram E , et al. Potential pitfalls in the work-up and diagnosis of choanal atresia. AJNR Am J Neuroradiol 1998; 19 (2) 326-329
- 15 Dunham ME, Miller RP. Bilateral choanal atresia associated with malformation of the anterior skull base: embryogenesis and clinical implications. Ann Otol Rhinol Laryngol 1992; 101 (11) 916-919