Choanal Atresia

Etiology:
— Congenital obstruction of nasopharynx due to narrowing and closure of posterior choanae and medialization of pterygoid plates and lateral nasal wall
— 90% bony, 10% membranous
— Most commonly unilateral
Imaging CT:
— Axial images should be reformatted to be parallel to the plane of the anterior hard palate
— Vomer thickened and bowed causing narrow choana
DDX: Pyriform aperture stenosis
Complications:
Treatment: Bony atresia requires significant reconstruction
Clinical:
— Presentation depends upon severity and whether it is bilateral versus unilateral
— Presentation may be inability to pass nasogastric tube or infant with respiratory distress on feeding
— Most common nasal anomaly
— May be isolated or associated with a number of syndromes
— Syndromic association is more common in bilateral atresia
— Associated with CHARGE association (Coloboma (80%), Heart defects, Atresia of choana (50%), Retardation, Genitourinary anomalies, semicircular canal dysplasia of Ear (90%), Arhinencephaly (50%))

Radiology Cases of Choanal Atresia

Radiology Cases of Bony Choanal Atresia

Radiograph of choanal atresia — AP + lateral radiographs of the airway after the injection of contrast into the nares bilaterally shows no passage of contrast into the oropharynx with the obstruction at the level of the vomer.

CT of choanal atresia — Axial CT without contrast of the face shows thickening and bowing of the vomer bilaterally resulting in narrow choana bilaterally.

CT of left choanal atresia — Axial CT without contrast of the maxillofacial bones shows thickening and bowing of the vomer to the left resulting in a narrow left choana.

CT of choanal atresia — Axial CT without contrast of the face shows thickening and bowing of the vomer bilaterally resulting in narrow choana bilaterally.

Radiology Cases of Membranous Choanal Atresia

CT of membranous choanal atresia — Axial CT without contrast of the face shows thickening and bowing of the vomer to the right resulting in narrow right choana.