Head and Neck Imaging

Choanal atresia

congenital malformation, in which one or both choanae have not opened during foetal development. Stenosis of the choanae is probably more common than atresia. Bony atresia is more common than membranous atresia. Unilateral atresia is more frequent, and may pass unnoticed until the infant is older; unilateral atresia usually presents with ipsilateral purulent rhinorrhoea. Bilateral atresia results in severe respiratory distress during feeding. CT is the imaging method of choice: in bony atresia, the vomer appears thickened and is fused with the inwards bowing posteromedial maxilla; in membranous atresia, the vomer appears less thickened, and the choanae are narrowed and filled with soft tissue (Fig.1).

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Fig.1

Bony narrowing of the right choana, filled with soft tissue (arrow): unilateral membranous choanal atresia.
Choanal atresia, Fig.1