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Radiographic Interpretation > Radiopacities Outside the Jaws > Flashcards

Radiopacities Outside the Jaws Flashcards

1
Q

what are tonsilliths from

A

repeated inflammation, the tonsillar crysts enlarge and incomplete resolution of organic debris (dead bacteria and pus, epithelial cells, and food) can lead to dystrophic calcification

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2
Q

how do tonsilliths appear on radiographs

A
  • cluster of small radiopacities
  • on pano: single or multiple radiopaque entities superimposed over the mid portion of the ramus
  • on CBCT: in the tonsils or adenoids surrounding the airway
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3
Q

what are the types of tonsils

A
  • pharyngeal tonsils
  • tubal
  • palatine tonsils
  • lingual tonsils
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4
Q

what is the management for tonsilliths

A
  • small lesions: no treatment if not symptomatic. with symptomatic patients tonsilliths may be removed manually
  • large lesions: require tonsillectomy
  • in elderly immunocompromised patients treatment may be considered because of the risk for aspiration pneumonia
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5
Q

what are calcified lymph nodes caused by

A
  • pts who have history of chronic inflammation
  • can be the result of tuberculosis, sarcoidosis, metastases of thyroid cancer or associated with a patients who have been treated for lymphoma - radiation
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6
Q

the presence of calcification in lymph nodes implies:

A

either active disease or disease that has been previously treated

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7
Q

in calcified lymph nodes, the lymphoid tissue becomes replaced by:

A

calcium salts

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8
Q

calcified lymph nodes have a ____ shape

A

cauliflower

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9
Q

are calcified lymph nodes symptomatic

A

generally no

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10
Q

what is atherosclerosis

A
  • calcification of the atheromatous plaque within the intima of arteries
  • the lumen is narrowed -> increased risk of cerebrovascular accident
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11
Q

how does atherosclerosis appear on pano

A
  • verticolinear radiopacities
  • mostly seen at the carotid bifurcation (C3 and C4)
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12
Q

how does atherosclerosis appear on CBCT

A
  • radiopaque circular on axial view or linear on sagittal or coronal view radiopacity located anywhere in the course of any artery
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13
Q

what can atherosclerosis be confused with on pano

A

thyroid or triticeous cartilage

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14
Q

where is thyroid and triticeous cartilage found

A

at the level of the hyoid bone or below

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15
Q

what is the distinguishing feature of thyroid cartilage

A

the border is more RO

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16
Q

where are rhinoliths found

A

within the nasal cavity

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17
Q

where are antroliths found

A

within the paranasal sinuses

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18
Q

what is the antrolith, its source, and describe it

A
  • calcified mass in the sinuses, most commonly in the maxillary sinuses
  • the source is usually endogenous (chronically inflamed mucosa)
  • deposition of mineral salts around a central nidus (lamination)
  • not attached to the sinus walls
  • mostly asymptomatic however expanding mass can impinge on the mucosa producing pain, congestion and ulceration
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19
Q

what is the DDX for the antrolith

A

osteoma

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20
Q

describe the rhinolith

A
  • calcified mass in the nose ( usually an exogenous foreign body)
  • deposition of mineral salts around a central nidus (lamination)
  • not attached to the nasal cavity walls
  • mostly asymptomatic however expanding mass may impinge on the mucosa, producing pain, congestion and ulceration
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21
Q

what is the periphery and shape of rhinoliths and antroliths

A

various shapes and sizes depending on the nature of the nidus but all have well defined periphery

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22
Q

describe the internal structure of the rhinolith and antrolith

A

homogenous or heterogenous radiopacities depending on the nidus, and sometimes may have laminations

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23
Q

what is the treatment for rhinolith and antrolith

A

referral to an otolaryngologist for endonasal or sinus endoscopic surgical removal

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24
Q

what is the incidence of sialoliths

A
  • submandibular gland (83-94%)
  • parotid gland (4-10%)
  • sublingual gland
  • minor salivary glands stones are exceedingly rare occuring mostly in the upper lip and buccal mucosa
25
Q

patients may be asymptomatic with sialolith but they may have a history of:

A

pain and swelling at mealtimes

26
Q

what are the imaging features of the sialolith

A
  • periphery: usually are cylindrical and very smooth
  • internal structure: radiopaque
  • multiple sialoliths are somewhat common
27
Q

how do ossified stylohyoid ligaments feels

A

by palpation over the tonsils as a hard, pointed structure

28
Q

what is eagles syndrome

A

pain from calcified stylohyoid ligament

29
Q

symptoms of eagles syndrome can be related to_____. this is a _____ diagnosis

A
  • cranial nerve impingement
    clinical
30
Q

what is the DDX for ossified stylohyoid ligament

A

sometimes symptoms may be similar to TMD

31
Q

what is the management of ossified stylohyoid ligament

A
  • asymptomatic patient: no tx
  • patients with persistent or intense symptoms: amputation of the stylohyoid ligament
32
Q

what is another name for the mucous retention pseudocyst

A

antral retention pseudocyst

33
Q

what is a mucous retention pseudocyst

A

accumulation of mucous within soft tissue lining in paranasal sinus due to obstruction of gland within the sinus lining

34
Q

describe the features of the mucous retention pseudocyst

A
  • not a true cyst - not lined by epithelium
  • always attached to a wall
  • dome shaped radiopaque mainly found in maxillary sinus followed by sphenoid sinus and less often in the frontal sinuses and ethmoid air cells
35
Q

antral retention pseudocysts are not related to:

A

the teeth or associated with periapical inflammatory disease

36
Q

what is the etiology for the mucous retention pseudocyst

A

blockage of the secretory ducts of the glands in the sinus mucosa resulting in accumulation of secretions and swelling of the tissue

37
Q

what are the clinical features of the mucous retention pseudocyst

A
  • rarely causes any signs or sympotms
  • it is an incidental finding
  • when a pseudocyst completely fills the maxillary sinus cavity, it may prolapse through the ostium and cause nasal obstruction
  • the retention pseudocyst may also rupture as a result of abrupt pressure changes caused by sneezing or blowing of the nose producing postnasal discharge
38
Q

what are the imaging features of the mucous retention pseudocyst

A
  • range widely in size from the size of a fingertip to a size large enough to fill the sinus completely
  • single or multiple
  • well defined non corticated smooth dome shaped and homogenous radiopaque masses
  • there are no effects on the surrounding structures
39
Q

what is the management for the mucous retention pseudocyst

A
  • no treatment (resolve spontaneously without any residual effect on the antral mucosa)
  • check patency of ostiomeatal complex if large
40
Q

what is mucositis

A

localized inflammatory change leads to thickening of the mucosal lining (infection, chemical irritation allergy, introduction of a foreign body or facial trauma
- incidental finding on images
- well defined non corticated radiopaque band of soft tissue density that follows the contour of the bony wall of the sinus

41
Q

what is sinusitis

A

generalized inflammatory condition of the sinus mucosa caused by an allergen, bacterium or virus
- ciliary dysfunction -> retention of sinus secretions (blockage of the ostiomeatal complex)

42
Q

what is pansinusitis

A

sinusitis affecting all the paranasal sinuses

43
Q

what are the 3 types of sinusitis based on time-

A
  • acute sinusitis: has been present for 4 weeks or less
  • chronic sinusitis: has been present for more than 12 consecutive weeks
  • subacute sinusitis: lasting for more than 4 weeks up to 12 weeks
44
Q

what are the clinical features of sinusitus

A
  • the most common sinus conditions that cause pain and tenderness to pressure over the involved sinus
  • pain and sensitivity to percussion may also be referred to the premolar and molar teeth on the affected side
  • could be a complication of the common cold, allergies, dental infection, virus or fungal infections
45
Q

what are the imaging features of sinusitis

A
  • generalized thickening of the mucosal lining around most or all sinus cavity walls
  • may cause blockage of the sinus ostium
  • acute: air entrapment (bubbles)
  • chronic: thickening and sclerosis of the walls
46
Q

chronic sinusitis may result in:

A

persistent radiopacification of the sinus with sclerosis and thickening of the walls

47
Q

what is the management of sinusitis

A

the goal is to control the infection, promote drainage and relieve pain

48
Q

what is the tx for acute sinusitis

A
  • treated pharmacologically to reduce mucosal swelling
  • antibiotics
49
Q

what is the tx for chronic sinusitis

A
  • goal is ventilation and drainage
  • endoscopic surgery is used to enlarge obstructed ostia or alternative path of drainage maybe established
50
Q

what is a mucocele

A

an expanding, destructive lesion that results from a blocked sinus ostium

51
Q

mucocele blockage may result from:

A

intra-antral or intranasal inflammation, polyp or neoplasm and the entire sinus becomes the pathologic cavity

52
Q

as mucous secretions accumulate and the sinus cavity fills, the increase in pressure within the cavity with a mucocele results in:

A

thinning and displacement of the sinus walls and in some cases wall destruction

53
Q

more than _____ of patients with mucocele have opthalmic symptoms and signs

A

greater than 90%

54
Q

what are the opthalmic signs and symptoms in mucocele

A

periorbital swelling, pain, exopthalmos, and visual disturbances

55
Q

what are the clinical features of the. mucocele

A
  • sensation of fullness in the cheek, and the area may swell
  • in the maxillary sinus -> pressure on the superior alveolar nerves causing radiating pain
  • if the lesion expands inferiorly, it may cause loosening of the adjacent posterior teeth
  • if the medial wall of the sinus is expanded the lateral wall of the nasal cavity deforms and the nasal airway may become obstructed
  • if the lesion expands into the orbit it may cause diplopia or proptosis
56
Q

about 90% of mucoceles occur in:

A

the ethmoid air cells and frontal sinuses

57
Q

when the mucocele is associated with the maxillary antrum:

A

teeth may be dispalced or roots resorbed

58
Q

what is the tx for mucocele

A

surgical excision

59
Q
A

Radiographic Interpretation (13 decks)

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