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
  • Imaging: vomer thickened + bowed causing narrow choana
  • CT: axial images should be reformatted to be parallel to the plane of the anterior hard palate
  • Clinical: most common nasal anomaly, hypoxia with feeding but if unilateral may be asymptomatic, nasogastric tube will not pass, associated with CHARGE association (Coloboma (80%), Heart defects, Atresia of choana (50%), Retardation, GU anomalies, SCC dysplasia of Ear (90%), Arhinencephaly (50%))

Radiology Cases of 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.