CWRU Links
Cases

Image Challenge


November 2015


 

A 43-year-old female was referred by an ENT surgeon to evaluate the radiopaque entity noted in the maxillary sinus. Panoramic radiograph revealed a well-defined, round, smooth radiopaque mass in the left maxillary sinus which is shown as circle in this cropped pano.

 

INCORRECT.

The shape and size are not consistent with root fragment. Additionally, there is no evidence of radiolucent pulp or radiopaque lamina dura surrounding the radiopaque entity.  

 

CORRECT.

Antroliths are formed as a result of deposition of minerals. They are noted as incidental finding on the radiographs and are usually asymptomatic. On radiographs they appear as well defined, circumscribed radiopaque structures. The internal content is mostly homogenous and radiopaque in nature as noted in this panoramic radiograph. Large and symptomatic antroliths require referral to otolaryngologist for surgical intervention.

November 2015 References

White, Stuart C., and Michael J. Pharoah. Oral Radiology: Principles and Interpretation, 7th Edition. Mosby, 2014. VitalBook file.

 


October 2015


 

A 10-year-old female presented to the Pediatric Dental Clinic for her very first dental exam, radiographs, and prophy. On review of her pano, a radiopaque lesion at the apex of #20 extending coronal to approximately the mid-root was noted. Clinically, #20 had no carious lesions associated with it; no sign of fistula present, and no percussion sensitivity was noted.

 

INCORRECT.

Condensing osteitis is the sequelae of dental caries progressing into pulpal necrosis leading to increased radio density in the apical region of the tooth. Based on the radiographic exam there is no evidence of dental caries, lamina dura surrounding the tooth is intact and PDL appears to be WNL. 

 

INCORRECT.

Periapical osseous dysplasia (POD) presents as a radiolucent entity in its initial phase, followed by radiopaque presentation in the mature stage. Mature stage is surrounded by thick sclerotic border. POD is most commonly seen in the lower anterior region.

 

 

CORRECT.

The region of interest demonstrates a solitary, well-defined, regular, smooth, radiopaque entity apical to #20 is noted. The internal aspect is uniformly radiopaque and there is no radiolucent rim surrounding this entity. It doesn’t appear to be causing any root resorption of #20. The localized area of revealing increased density that is not related to either inflammatory or dysplastic changes are referred as dense bone island or focal idiopathic osteosclerosis. Very rarely they can cause root resorption. No treatment is required for this condition.


October 2015 References

White, Stuart C., and Michael J. Pharoah. Oral Radiology: Principles and Interpretation, 7th Edition. Mosby, 2014. VitalBook file.

 


September 2015


 

A 41-year-old female presented to the oral medicine and diagnostic clinic with pain in the lower right mandible. After clinical examination, radiographs were obtained. The lower right PA showed two well-defined, radiopaque, lesions in relation to the root portion of tooth #30. The periphery appears to be smooth and continuous, producing a bulbous root portion. The likely diagnosis of this condition is?

 

INCORRECT.

The general presentation of cementoblastoma's growth is in a concentric fashion. Cementoblastoma are mixed density lesions with a radiating pattern, giving an appearance of a wheel spoke. Additionally, they can cause external root resorption. These characteristic features are missing.

 

CORRECT.

The internal architecture is more radiolucent than the tooth simulating cementum. The lamina dura and PDL are intact. The bulbous root portion is caused by excessive cementum, especially in the apical third of the root portion. The radiographic findings are consistent with hypercementosis. 

 

INCORRECT.

Periapical apical sclerosing osteitis will be more diffuse with radiopaque sclerotic presentation and will not have a radiolucent rim.

 


September 2015 References

White, Stuart C., and Michael J. Pharoah. Oral Radiology: Principles and Interpretation, 7th Edition. Mosby, 2014. VitalBook file.