choanal atresia

Membranöse,
beidseitige Choanalatresie bei einem Neugeborenen. Darstellung in der Computertomographie axial und koronar (1 mm, Knochenfenster, IMR). Da die beidseitige Choanalatresie ein Notfall ist, ist das Kind intubiert.
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Infant with
difficulty with nose breathing when the left nostril is occluded. Axial CT without contrast of the face shows thickening and bowing of the vomer to the right resulting in narrow right choana.The diagnosis was membranous right choanal atresia.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant who
cannot have a nasogastric tube passed through either nare. Axial CT without contrast of the face shows thickening and bowing of the vomer bilaterally resulting in narrow choana bilaterally.The diagnosis was bilateral choanal atresia.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn who
cannot have a nasogastric tube passed through the left nares. Axial CT without contrast of the maxillofacial bones shows thickening and bowing of the vomer to the left resulting in a narrow left choana.The diagnosis was left choanal atresia.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
inability to pass a nasogastric tube through either naresAxial CT without contrast of the face shows thickening and bowing of the vomer bilaterally resulting in narrow choana bilaterally.The diagnosis was choanal atresia.
pediatricimaging.org • CC-by-nc-sa 4.0
Membranöse
Choanalatresie beidseits: Computertomografie axial und koronar (Low Dose, IMR).
Wikipedia • CC BY-SA 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Choanal atresia refers to a lack of formation of the choanal openings. It can be unilateral or bilateral.

Epidemiology

It frequently presents in neonates where it is one of the commonest causes of nasal obstruction in this age group. There is a recognized female predilection. The incidence is estimated at ~1:5000-8000.

Clinical presentation

Presentation depends on whether it is uni- or bilateral. Unilateral choanal atresia presents late and can be asymptomatic or present with rhinorrhea. Bilateral atresia can present with neonatal respiratory distress as infants are obligate nose breathers. Another finding is failure to pass a nasogastric tube.

Approximately two-thirds of cases are unilateral .

Pathology

Structurally there are two main types:

  • osseous: ~90%
  • membranous: ~10%
Associations

Syndromic associations include

Other associations include

General pathogenesis includes

Radiographic features

CT

Assessment with axial CT may show:

  • a uni- or bilateral posterior nasal narrowing with an obstruction
  • airway less than 3 mm
    • measurement done at the reference level of the pterygoid plates in the axial plane
  • an air-fluid level above the obstruction point
  • thickening of the vomer
  • medial bowing of posterior maxillary sinus

Treatment and prognosis

Options include:

  • endoscopic perforation (for membranous types)
  • full choanal reconstruction

Differential diagnosis

On an axial CT scan consider:

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Choanalatresie:
Stenose der
Apertura piriformis
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membranöse
Choanalatresie
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beidseitige
Choanalatresie
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