HEAD AND NECK Flashcards

Question

NPC ddx

Answer 1

DDX small - adenoidal tissue - nasopharyngeal lymphoma - low grade or other early primary malig DDX large - mets - adenoid cystic - plasmacytoma - fibrosiing pseudotumour - lymphom - chordoma - chondrosarcoma - meningioma - JNA

Answer 2

Tx T0 - EBV positive node TIS T1 - confined to nasopharynx OR - extends to oropharynx or nasal cavity wihtout parapharyngeal invovlement T2 - extends to paraphryngeal space AND OR - medial pterygoid, lateral pterygoid, prevertbral muscles T3 - skull base, cervical vertebra, pterydoid plates, pterygopalatine fossa, paranasal sinuses T4 - intracranial - cranial nerves - hypopharynx - orbit - parotid - soft tissue beyond lateral pterygoid

Answer 3

T1-3 defined by site SUUPRAGLOTTIS T1 limited to one subsite, normal cord mobility - suprahyoid epi - aryepiglottic folds - infrahyoid epiglottis - false cords - arytenoids T2 invades mucosa adjacent area, normal cord mobility - subsite supraglottis - glottis - region outside supraglottis; base of tongue, vallecula, medial wall pyriform sinus T3 limited to larynx with vocal cord fixation and/or invasion of - innner cortex thyroid cart - paraglottic space - preepiglottic space - post cricoid area GLOTTIS T1 limited to cord with normal mobility T1a one cord T1b both cords T2 extends to supra or subglottis AND/OR impaired vocal cord mobility T3 larynx with cord fixation AND/OR invasion of paraglottix space AND OR inner cortex thyroid cartilage SUBGLOTTIS T1 limited to subglottis T2 extneds to cords without fixation T3 limited to larynx with cord fixation AND OR invasion of paraglottis AND OR inner cortex thyroid cart SAME FOR ALL T4a - outer cortex thyroid cart - cricoid cart - tissue beyond larynx T4b - mediastinum - prevertebral space - encases carotid artery

Answer 4

rare benign acquired cyst at the floor of mouth. result from obstruction of a sublingual gland or adjacent minor gland. can be simple or plunging - simple: confined to sublingual space - plunging: extends to submandibular space, either around posterio edge of mylohyoid or through a deficiency, mylohyoid boutonniere

Answer 5

Connection to sublingual space US - thin walled, cystic lesions - can be complex if infected CT - thin walled fluid attenuation. can have superimposed infection. MR T1 low T2 high C+ wall can enhance DDX - dermoid/epidermoid - cystic hygroma - cervical abscess - thyroglossal duct cyst - 2nd branchial cleft cyst

Answer 6

may present as a cause of dysphagia presents as a cricopharyngeal bar at C5/6 on fluoro complcations - hypertrophy - zenkers

Answer 7

causes - neck/superior thoracic mass, aortic path, osteophytes - masses affecting vagus nerve - iatrogenic injury - idiopathic - blunt and penetrating trauma - congenital anomalies eg meningomyelocele, chiari, hydroceph imaging - enlarged piriform sinus - medialisation aryepiglottic fold - enlarged laryngeal ventricle - atrophy thyroarytenoid muscle - anteromedial deviation arytenoid cartilage - abducted vocal cordon breath hold, compensatory medial bowing of hte contralateral

Answer 8

Post intubation Sparing posterior wall - Relapsing polychondritis (smooth) - Tracheobronchiopathia osteochondroplastic (nodular) Involving posterior wall - amyloid - wegners - sarcoid

Answer 9

a rare multisystem disease characterised by recurrent inflammation of the cartilaginous structures in the body. Airways commonly involved

Answer 10

a rare idiopathic non neoplastic airway abnormality, with nodular thickening of the cartilage. can be cartilaginous or calcified.

Answer 11

Non specific, can be seen in asx patients XR - opacification CT - peripehral mucosal thickening - gas fluid level - OMC obstruction - maxillary dentition MR T1 mucosa iso, fluid hypo T2 hyper C+ mucosa enhances Complications - subperiosteal abscess incl orbitla and pott puffy - dural sinus thrombosis - meningitis empyema, abscess

Answer 12

infection over 12 weeks. commonly assoc anatomical variants incl - concha bullosa - posterior nasal septal deviations - uncinate process variations - paradoxical middle turbinate - agger nasi cells - haller cells sclerotic thickening bone from prolonged mucoperiosteal reaction. intrasinus calc may be present. five main patterns; 1. OMC: max,. ant eth, front 2. infundibular: isolated ethmoid infundibulum and/or maxillary sinus ostium 3. sphenoethmoidal recess: sphenoid and posterior eth 4. sinonasal polyposis 5. sporadic

Answer 13

pneumatisation of the middle turbinate, commonly assoc with septal deviation

Answer 14

inferomedially curved middle turbinate edge with concave surface facing the nasal septum, usually bilat

Answer 15

most anterior ethmoidal air cells - anterolateral and inferior to frontal recess - anterior and above attachment of middle turbinate - within the lacrimal bone, related laterally to orbit, lacrimal sac, NL duct

Answer 16

anterior ethmoidal air cells extending posteriorly and superiorly over the orbit from the frontal recess

Answer 17

Posterior ethmoidal air cell, extends posteriorly to lie superolateral to sphenoid sinus in close prox to ICA and optic nerve. often extends to anterior clinoid process.

Answer 18

ethmoid air cells lateral to the maxilloethmoidal suture along the inferomedial orbital floor

Answer 19

Non invasive; hypae do not invade mucosa - allergic fungal - sinus fungal mycetoma Invasive; hypae in mucosa and beyond - acute invasive - chronic invasive - granulomatous invasive

Answer 20

CT - sinus opacification - central serpinginous hyperdense materal - expangion - remodelling/thinning - erosion MR - T1 hypo mucosa, variable T2 - hyperintense mucosa - low centrally C+ mucosa enhancement DDX sinonasal polyposis sinus fungal mycetoma - usually one side, no hyperimmune response sinonasal mucocele - same chronic expansive features, no erosions non hodgkins lymphoma - homogenous

Answer 21

CT - typically single sinus, common is maxillary then sphenoid - soft tissue with or without calcs - can have post obstructive/chronic sinusitis features - no bone erosions MR T1 low T2 low C+ mucosa might enhance DDX allergic fungal sinusitis chronic invasive fungal sinusitis - bone erosion paranasal sinus mucocele sinonasal inverted papilloma

Answer 22

most aggressive form fungal sinus disease. seen mostly in immunocompromised patients. aspergillus in neutropaenia and zygomycetes in diabetes

Answer 23

CT - NO internal hyperdensity, unlike chronic - mucosal thickening - opacification of the sinus - bone destruction - fat stranding outside sinus perimeter, including periantral fat stranding MR T1 intermediate to low T2 fungal mass low to intermediate - black turbinate sign; non enhancement nasal turbinates from invasion/necrosis C+ absent mucosal enhancement suggests necrosis, invasion Assess in particular for - stranding of the periantral fat - intraorbital, masticator, pterygopalaitine - subtle enhancement - leptomeningeal enhancement - intracranial granulomas - cavernous sinus thrombosis - carotid pseudoaneurysm - cerebrtits/abscess

Answer 24

more than 12 weeks CT - homogenous opacification iso to hyper - lack of expansion - mottled bone destruction - focal bone erosion and extrasinus component - sclerotic change MR - iso to hypo - usually marked hypo

Answer 25

a form of invasive fungal sinusitis large expansive mass with bone destruction and local invasion. CT bone destruction hyperdense homogenous enhancement MR t2 dark DDX: malignant lesions incl - sinonasal SCC - sinonasal adenoid cystic - adenocaricnoma - SNUC - lymphoma - melanoma - esthesioneuroblastoma

Answer 26

also known as Wegeners, a multisysem necrotising non caseating granulomatous vasculitis affecting small to medium sized arteries/capilleries

Answer 27

sinusitis/mastoiditis/otitis sclerosing oteitis of the nasal cavity sinonasal mucosal ulcers lacrimal gland involvement nasal septal perf/deviation subglottic stenosis

Answer 28

the presence of multiple benign polyps in the nasal cavity and paranasal sinuses

Answer 29

extensive polyps occupying the nasal cavity and sinuses usually hypodense but can be hyper assoc local benign bone remodelling or erosion - mucoceles whole sinus expanded opacified ethmoid sinuses with convex lateral walls and air fluid levels concurrent infection can be present Meltzer 0 - no polyps 1 - single in middle meatus 2 - multiple in middle meatus 3 - extending beyond middle meatus 4 - nasal cavity obstruction

Answer 30

solitary sinonasal polyps that arise within the maxillary sinus. pass through the ostium to the nasapharynx and nasal cavity. can occur elsewhere less commonly. present with sinonasal obstruction

Answer 31

XR unilateral opac can see nasopharyngeal mass CT defined mass with mucin density widening of the maxially ostium extending to the nasopharynx no bony destruction, but smooth enlargement of the sinus can be dessicated and high density MR T1 intermediate to low T2 high homogenous C+ peripehral

Answer 32

type of Schneiderian papilloma representing an uncommon non cancerous sinonasal tumour most commonly seen in middle aged men. can undergo malignant transformation. classically have convoluted cerebriform on T2 and contrast imaging

Answer 33

CT non spec soft tissue density masswith enhancement location; most commonly lateral wall nasal cavity can have intralesional calc representing residual bone fragments MR distinctive convoluted cerebriform pattern on T2 and post con T1

Answer 34

a rare benign but locally aggressive vascular tumour of young men. vivdly enhancing soft tissue mass centred onthe sphenopalatine foramen. flow voids/s&p MR.

Answer 35

CT nasopharyngeal mass lobulated soft tissue mass cnetred on sphenopalatine fossa anterior bowing of the posterior maxillary wall marked enhancement Angio to see supply MR T1 intermediate T2 heterogenous, flow voids C+ prominent

Answer 36

1a nasal cavity/nasopharynx 1b exension to sinus 2a into pterygomaxillary fossa 2b fills pterygomaxillary fossa bowing psterior wall max antrum anterior or into orbit 2c beyond pterygomax fossa into infratemporal fossa 3 intracranial exnteion

Answer 37

a common incidental benign nasopharyngeal mucosal cyst

Answer 38

well cricumscribed rounded immediately deep to mucosa bw/anterior to longus colli muscles ct low density non enhancing can be hyperattenuating mr t1 variable due to protein t2 high C+ no enhancement

Answer 39

complate opacification of a sinus by mucus, often with bony expansion due to obstruction. clinical presentation depending on direction of expansion and presence of infection

Answer 40

cant have air in the sinus CT complete opacification margins expanded and thinned may have bony resorption attenuation is variable MR signal intensity highly variable depdning on water/protein/mucus T1 low most common T2 high most common C+ if present than peripheral DWI variable

Answer 41

a rare and highly aggressive neoplasm arising from the paranasal sinuses. Mostly ethmoid and superior nasal cavity.

Answer 42

Ethmoid/superior nasal cavity Bone destruction CT: enhances to variable degree MR T1 iso to muslce T2 iso to hyper to muscle C+ heterogenous

Answer 43

a tumour arising from the basal layer of the olfactory epithelium in the superior recess of the nasal cavity. Usually presents as a soft tissue mass in the anterior/middle ethmoidal cells extending through the cribriform plate to the anterior cranial fossa.

Answer 44

Slow growing Begin at superior olfactory recess Involve ant/mid ethmoidal cells often form dumbell with waist at cribriform CT soft tissue can have focal calcs homogenous enhancement bone can be remodelled rather than destroyed MR T1 heterogenous T2 heterogenous C+ variable, usually bright Peritumural cysts at intracranial aspect

Answer 45

Olfactory neuroepithelioma Olfactory groove meningioma Sinonasal carcinoma - lack peritumoural cysts Rhabdo NPC - more posterior, older

Answer 46

Kadish a: nasal cavity b: nasal cavity and paranasal sinuses c: extends beyond - BOS - intracranial - orbit - mets

Answer 47

primary tumours of the sinonasal region with glandular differentiation. Classified into salivery and non salivery, NS into intestinal and non intestinal

Answer 48

Ill defined, heterogenously enhancing Intestinal tends to be ethmoid/nasal cavity Non intenstinal maxillary CT aggressive bone destruction heterogenous enhancement MR intermedialte T1 and T2 possible haemorrhagic foci heterogenous enahcnement

Answer 49

Location - mostly frontal - tehn ehtmoid, max - rare in sphenoid Can be ivory, mature or mixed Assoc with Gardners CT well circumscribed mass of variable density, ranging from v dense to more ground glassy MR low intensit all sequences ddx - FD - other osteogenic - osteoblastoma, osteosarcoma, cementoossifying fibroma

Answer 50

a form of neural tube defect where brain and meninges herniate through a cranial defect. can have a stalk in 15% to brainbut no fluid tract distinguishing from nasal encephaloceole mass, without pulsations or increased size with valsalva or compression of ipsilateral jugular vein

Answer 51

a rare subtype of melanoma. typically expansile mass centred within the nasal cavity, or less commonely, the paranasal sinuses.

Answer 52

CT polypoid or mass like bone remodelling or erosion strongly enhancing MR T1 homogenoeus,can be high T2 low C+ moderate enhancement

Answer 53

involvment of hte nasal cav/paranasial sinuses with lymphoma. most commonly nasal cavity and maxillary sinus. generally t cell

Answer 54

can be discrete or diffusely infiltrating CT soft tissue attenuating can have bone destruction MR T1 intermediate T2 hypointense C+ typically homogenous

Answer 55

a chronic granulomatous infection involving the upper respiratory tract due to Klebsiella.

Answer 56

Nasal mass with the following features CT bilateral or unilateral expansile homogenous hyperdense and non enhancing can extend through nares and into sinuses no bone destruction MR T1 mild to marked high signal T2 hyper with hypointense foci of fibrosis C+ inhomogenous DWI restriction with low ADC DDX Granulomatous disease Lymphoma and sinonasal carcinoma

Answer 57

large proportion of all rhabdos and most common soft tissue sarcoma in the head and neck usually embryonal and in children can be orbital, parameningeal, middle ear or other

Answer 58

MR T1 iso to hyper T2 hyper C+ marked enhancement, usually heterogenous due to haemorrhage/necrosis Can have diffuse restriction

Answer 59

horizontal maxillary fracture floating teeth passes through - alveolar ridge - lateral nose - inferior wall maxillary sinus - pterygoid plates

Answer 60

pyramidal fracture, teeth at base and nasofrontal suture at apex floating maxilla fracture arch passes through - posterior alveolar ridge - lateral wall maxillary sinus - inferior orbital rim - nasal bone - pterygoid plate

Answer 61

craniofacial disjunction floating face transverse line through - nasofrontal suture - maxillofrontal suture - orbital wall - zygomatic arch/zygomaticofrontal suture - pterygoid plates

Answer 62

Pterygoid plates Type 1 - anterolateral margin nasal fossa Type 2 - inferior orbital rim Type 3 - zygomatic arch Nasofrontal suture means type 2 or 3

Answer 63

zygomatic arch inferior orbital rim, anterior/posterior maxillary sinus walls lateral orbital rim Imaging - fracture of the arch and/or temporozygomatic suture diastasis - fracture of the inferior orbitall rim, anterior and posterior maxillary sinus wall and/or zygomaticomaxillary suture - fracture of the lateral orbital rim and/or diastasis of the frontozygomatic suture

Answer 64

fractures involving the central upper midface. high impact to nose transmitted through ethmoid comminution of both medial maxillary buttresses results in a pattern of fractures involving the nasal bones, septum, ethmoid sinuses and medial orbital walls associated injuries - telecanthus - nasolacrimal duct - orbital injuries - CSF rhinorrhea - epiphora

Answer 65

inflammation of the salivery glands causes - acute bacteria (staph and strep v) - stones - dehydration, immunosuppression, iatrogenic, cancer assoc - sjogren - mikulicz - post radiation - i-131 - HIV/IRIS

Answer 66

US - enlarged - hypoechoic - hyperaemic - chronic; atrophic, hypoechoic, irregular margins CT - enlarged, abnormal attenuation, indistinct margin, contrast enhancement - stranding - silated duct - enlarged nodes - abscess MR - Acute T1 low, T2 high - Chronic T1 inhomgenous low, T2 low

Answer 67

almost always submandibvular wharton duct then parotid duct

Answer 68

a benign mixed tumour, occuring most commonly in the salivery glands. most common SG tumour. well circumscribed mass commonly in the parotid,hypoechoic on us and t2 bright with homogeneous enhancement small risk of malig transformation to carcinoma ex pleomorphic adenoma

Answer 69

80% parotid 10% SMG minor 6% sublingual 1% also commonly found in lacrimal gland

Answer 70

rounded mass with bosselated or polylobulated borders commonly superficial lobe parotid can be deep lobe, extraparotid extendinfg to prestyloid parapahrynfeal space and stylomandibular tunnel US hypoechoic posterior acoustic enhancement CT homogeneous attenuation prominent enhancement larger can be heterogenous M T1 low T2 high+, decreased signal rim C+ homogenous enhancement

Answer 71

When in parotid; - warthin - mucoepidermoid - myoepithelioma - adenoid cystic carc - mets - lymphoma - facial schwannoma

Answer 72

benign tumours of the salivary glands most common from the parotid tail can be bilateral/multifocal second most common after pleomorphic

Answer 73

commonly parotid tail at the mandibular angle sometimes elsewhere undergo cystic change more than any other salivary gland tumour US ovoid well defined multiple irregular spongelike areas larger; more cysts hypervasc CT well defined heterogenous solid cystic within the superficial parotid no calc moderate enhancement mural nodule common b/l MR well def and bilateral T1 low to intermediate, cysts have cholesterol and can be high T2 heterogenous and variable signal C+ solid parts enhance

Answer 74

benignity proportional to size - parotid commonly benign, SMG 50/50, minor mostly malig SUBTYPES Benign: epithelial - pleomorphic adenoma - warthin - intraductal papilloma - oncocytoma - myoepithelioma Benign: non epithelial - haemangioma - lymphangioma - lipoma Malignant - mucoepidermoid - Adenoid cystic carc - myoepithelioma - adenocarc - acinic cell carc - squamous - carcinoma ex pleomorphic adenoma - salivary duct carcinoma - metastases (cut SCC, melanoma, seminoa) - lymphoma

Answer 75

most common malignant primary of the parotid. also occur at hard palate commonly

Answer 76

US hypoechoic well circum CT well circum usually cystic components solid bits enhance calcs sometimes seen look like PMA higher grade; infiltrative MR low grade (like PMA) - T1 low to intermediate - T2 intermediate to high, cystic high - C+ heterogenous enhancement solid high grade - lower T2, poorly defined margins and infrequent cystic areas - assess for perineural spread

Answer 77

second most common malig ofthe minor salivary glands behind mucoepidermoid locally aggressive with propensity for perineural spread

Answer 78

Low grade; well defined High grade; infiltrative Frequently assoc with perineural spread MR T1 hypo to iso T2 hyper, higher grade more hypointense C+ homogeneous

Answer 79

a condition of lymphatic infiltration of the salivary glands, particularly the parotids

Answer 80

US numerous cysts/hypoechoic spaces without posterior enhancement straight up cysts for real CT/MRI bilateral salivary enlargement with intraglandular cystic and solid masses increased lymph nodes\ main jenny diffy would probably be sjogren they get multicystic appreance f the parotids, can be salivary glands

Answer 81

Cleidocranial dysostosis Gardner syndrome Cleft palate

Answer 82

a supernumery tooth in the palatal midline between the two maxillary central incisors

Answer 83

impaction or delayed eruption central incisors widening of incisor gap abnormal poistion or curve of the incisors resorption incisors dentigerous cysts nasal cavity eruption

Answer 84

Apical periodonitis (granuloma/abscess) Periapical cyst Cemento-osseous dysplasia Tumours Trauma Residual cyst

Answer 85

also known as radicular cysts, most common cystic lesions. result from infection. generally small <1cm, round, pear shaped, thin rim of cortical bone usually restoration/cary of the adjacent tooth

Answer 86

a mass like region of granulation tissue in relation to teeth infection tend to be higher attenuating than periapical cysts

Answer 87

acute infection of the periapical tissue around the root of the tooth

Answer 88

Imaging - well defined lucency - adjacent caries - adjacent empty socket Complications - OM - CNS infection - ludwig angina - deep space infection - sinusitis

Answer 89

abnormaly displacement with loss of normal articulation with the glenoid fossa can be - anterior - cranial - posterior anterior - most common - exaggerted and often recurrent normal anterior translocation of the condyule from the fossa cranial - rare, from upward force directing the condyle through the glenoid fossa into the middle cranial fossa posterior - rare

Answer 90

synovial joint mandibular condyle and temporal mandibular fossa/glenoid fossa also anterior articulating eminence articular disc - anterior band, intermediate band, posterior band posterior band connects to bilaminar cartilage which connects to posterior capsule lateral pterygoid to anterior capsule

Answer 91

disc is low signal all sequences, biconcave, located between the condyle and temporal bone with the posterior band at the 12 oclock position and the angle between the PB posterior limit and the vertical condyle <10deg can be anteriorly displaced in asx patients, only about 30% sx

Answer 92

Direct signs - anterior disc displacement; displaced in closed mouth, can reduce when open (recapture) or not - posterior disc displacement; posterior band displcaed posteriorly beyond 1oclock - stuck disc; fails to displace in open or closed mouth position, fixed to temporal bone Indirect - large effusion - rupture of retrodiscal layers - thickening of the lateral pterygoid muscle attachment - OA changes

Answer 93

osteonecrosis following radiation therapy due to its superficial position. imaging - cortical destruction - sequestration - absence of a soft tissue mass

Answer 94

bony destruction of the jaw with exposed bone present for greater than 8 weeks in the presence of antiresorptive/antiangiogenic medication and absence of radiotherapy can get it with (OP, malig, immunosupp) - bisphosphanates - mabs - tyrosine kinase inhibs - VEGF inhibs - mTOR inhibs imaging - lucent or mixed lesion - sequestrum - periosteal prolif/rxn

Answer 95

rare non odontogenic soft tissue developmental cysts occurring inferior to the nasal alar region

Answer 96

simple cyst in the nasolabial region separated from bony structures and teeth

Answer 97

developmental non neoplastic cysts arising from degenration of the nasopalatine ducts. develop in the midline anterior maxilla.

Answer 98

slow growing, benign, non inflammatory odontogenic cysts. present as a well defined unilocular radiolucency surrounding the crown of an unerupted tooth within the mandible assoc with - mucopolysacc - basal cell naeuvys syndrome

Answer 99

cystic expansile pericoronal lesion containing the crown of an impacted tooth tend toi attach to cementoenaml junction thin regular sclerotic margin variable size MR t1 low T2 high no enhancement

Answer 100

a cortical defect near the angle of the mandible below the mandibular canal. can be filled by SMG or fat.

Answer 101

RA Ank spond CPPD Gout Psoriatic arthritis SLE JIA

Answer 102

rare, benign cystic lesions involving the mandible or maxilla. typically appear as expansile solitary unilocular lesion in the posterior mandible assoc - basal cell naecus (or Gorlin Goltz) - margans - noonan

Answer 103

solitary radiolucent unilocular expansile smooth corticated borders typically posterior mandible large enough; resorp roots of tooth can sometimes be septated MR T1 high T2 heterogenous DWI restricts C+ peripheral enhancment no nodular component

Answer 104

a locally aggressive benign tumour arising from the mandible or sometimes maxilla

Answer 105

90% multicystic, soap bubble lesions well demarcated borders no matrix resorption of adjacent teeth can be unicystic and pericoronal, similar to dentigerous, OKC, ameloblastic fibromas MR mixed solid and cystic pattern thick irregular wall with enhancing papillary projections

Answer 106

most common odontogenic tumours of themmandible assoc with gardner syndrome

Answer 107

initially lucent, develops small calcs, eventually coalesce to form a radiodense lesion with a lucent rim

Answer 108

a variant of ICA that represents a collateral pathway resulting from involution of the normal cervical portion of the ICA enlargement of the small collaterals that pass lateral to the cochlear promotory - inferior tympanic aa (ECA) - caroticotympanic aa (petrous ICA) vessels rejoin the petrous segment. May present with pulsatile tinnitus

Answer 109

enlarged inferior tympanic canaliculus retrotympanic mass absent carotid plate absent or hypoplastic vertical segment of the carotid canal ddx - lateralised ICA: protrudes into the anterior mesotympanum but dosnt course across the cochlear promotory or enlarge the inferior tympanic canaliculus - petrous ICA aneurysm - glomus tympanicum - glomus jugulare - dehiscent jugular bulb

Answer 110

Fracture orientation - longitudinal - horizontal - mixed Otic capsule involvement, predicts; - faical nerve involvement -CSF leak - sensorineural hearing loss - epidural/SA haematoma Complications - facial nerve palsy - ossicular chain disruption - otic capsule involvement - CSG leak - meningitis - post traumatic cholesteatoma - perilymphatic fistula

Answer 111

CT - opacification - erosion of septa - erosion of lateral wall or sigmoid plate - soft tissue abscess - petrous apicitis - cerebral abscess or dural venous sinus thrombosis MR - opacification T1 low T2 high DWI possible C+ mucosal enhancement typical

Answer 112

complication of otomastoiditis deep to scm

Answer 113

complication of otomastoiditis abscess in digastric triangle (or OM of occipital bone, same name)

Answer 114

subperiosteal abscess bezold abscess citelli abscess labyrinthitis petyrous apicitis intracranial extension facial nerve dysfunction thrombosis of mastoid emissary vein (griesinger sign)

Answer 115

Otomastoiditis symptoms and - deep facial pain due to meckels cave inflammation - abducens nerve palsy (gradenigo syndrome) inflammation of dorellos canal

Answer 116

Congenital Acquired - priamry (no hx of infection) - secondary - pars flaccida - pars tensa External ear canal Mural cholesteatoma Petrous apex

Answer 117

Erosions - scutum, ossicles, lateral semicircular Dehiscence - facial nerve canal, tegment tympani Integrity of - epitympanum, aditus ad antrum, oval and round window Presence in sinus tympani

Answer 118

small recess in posterior mesotympanum medial to pyramidal eminence and stapedius muscle origin

Answer 119

Characteristically in the petrous apex MR T1 low T2 high FLAIR can have partial attenuation (unlike cholesterol granuloma) C+ non enhancing, or maybe margins DWI restricted diffusion

Answer 120

typically middle ear, result from chronic infection four hypothesis - invagination/negative pressure, eustachian tube dysfx and membrane retraction - invasion migration - basal cell hyperplasia - metaplasia complications - labyrinthine fistula - cochlear fistula - labyrinthitis - facial nerve dysfx - extension through IAM, middle cranial fossa, petrous apex

Answer 121

Depends on part of the TM it arises from; Pars flaccida - superior extension; expands into prussak space, eroding the scutum, displacing the ossicles medially - inferior extension; less common Pars tensa - posterosuperior; extends medial to the incus and displaces the ossicles laterally - anteiror and inferior MR T1 low T2 high C+ none DWI restricts

Answer 122

Cholesterol granuloma - high t1 - no enhancement - no restriction Mucoid impaction Glomus tympanicum Facial nerve schwannoma Post op: Recurrence - low t1 Granulation tissue - intermediate t1 - enhancement - low DWI Scarring - low T1/T2 - low DWI

Answer 123

Assoc - crouzon - treacher collins - goldenhar - pierre robin CT mention - middle ear cavity volume - ossicles (often involved) - inner ear structure, both windows need to be there - course of the ICA and jugular bulb - course of the facial nerve

Answer 124

absent sigmoid plate with a high riding jugular bulb. cause of pulsatile tinnitus and retrotympanic vascular mass.

Answer 125

Superior - vestibular and visual symptoms - tullio phenomenom - vertigo and nystagmus from loud noises - auditory dysfunciton Posterior - mostly hearing

Answer 126

Assoc - pendred syndrome - vestibular anomalies - cochlear anomalies - semicircular canal anomalies Imaging - enlarged vestibular aqueduct >1.5mm at the midpoint (valvassori) - opercular width >2mm (Cincinnati)

Answer 127

CT smooth expansile lesion MR T1 low to intermediate T2 high C+ no central, can have peripehral DWI no restriction DDX Cholesterol granuloma - should be high on T1

Answer 128

ossification of the membranous labyrinth as a response to insult, commonly infection but also surgery or trauma, autoimmune or sickle cell

Answer 129

Scala tympani of the basal turn of the cochlea is the most commonly affected site CT - mild: hazy increased density in the fluid spaces - moderate: focal areas of bony encroachments - severe: complete obliteration MR loss of normal high fluid signal

Answer 130

a primary osteodystrophy of the otic capsule. Can have conductive, sensorineural or mixed hearing loss. Commonly bilateral. Two phases - otospongiosis and otosclerosis Two subtypes - fenesteral and retrofenestral Fenestral (stapedial) - involves the oval window and stapes footplate - hearing loss is conductive due to fixation Retrofenestral (cochlear) - cochlear involvement and demineralisation of the cochlear capsule - hearing loss is sensorineural

Answer 131

Fenestral - just anterior to the oval window - fissula ante fenestram - bony overgrowth can cause fixation of the stapes Retrofenestral - second most common - invovlement of the round window niche - bone surrounding cochlea, can be focal or circumfrential Otospongiotic phase - demineralisation and spongy bone cause lucency Otosclerotic - region increases in attenuation DDX - OI - Pagets - osteoradionecrosis

Answer 132

Symons and fanning Grade 1 - solely fenestral Grade 2 - patchy localised cochlear disease a) basal cochlear turn b) middle/apical turns c) both basal and middle/apical turns Grade 3 - diffuse confluent cochlear invovlement of the otic capsule

Answer 133

sometimes called a choclate cyst of the ear or blue domed cyst special type of middle ear granulation tissue which is particularly prone to bleeding and frequent cause of haemotympancum most common cystic lesion of the petrous apex

Answer 134

CT - expansile well marginated lesion with thinned overlying bone - can look more aggressive/erosive at the petrous apex, less so in the middle ear MR T1 - high due to cholesterol component and methaemoglobin +/- haemosiderin rim T2 - central high signal - peripheral low signal rim FLAIR - no attenuation C+ can hve faint peripheral enhancement DWI - no restriction

Answer 135

Asymmetric marrow/pneumatisation Middle ear effusion Cholesteatoma Base of skull tumours Hydrated mucocele - can be identical Thrombosed ICA aneurysm - usually more complex - can have a residual flow signal

Answer 136

Modified stenvers view - positions it in the plane of the sueprior semicircular canal - cochleostomy in vertical plane with superior semicircular canal - electrodes should be medial to stomy

Answer 137

Sennaroglu 1. Complete labyrinthe aplasia (Michels) 1 ) with hypoplastic petrous b) without otic capsule c) with otic capsule 2. Rudimentary otocyst - round or ovoid cystic space in place of the inner ear - IAC absent - carotid canal absent - SCC may be present rudimentarily 3. Cochlear aplasia a) normal vestibule b) dilated vestibule 4. Common cavity - absent normal diff between cochlea and vestibule 5. Cochlear hypoplasia a) bud like b) cystic hypoplastic c) cochlea with less than 2 turns d) cochlea with hypoplastic middle and apical turns 6. Incomplete paritition of the cochlea - defects involving the modiolus and interscalar septa a) type 1 cystic cohleovestibular anomaly b) type 2 part of mondini (if enlarged vestibular aqueduct) c) type 3 X linked deafness 7. enlarged vestibular aqueduct 8. Cochlear aperture abnormalities

Answer 138

an abnormal small vessel arising form the petrous portion of the intenral carotid artery and crossing through the middle ear results from failure of regressin of the embryonic stapedial artery imaging - small canaliculus originating from the petrous segment of the ICA - linear segment of soft tissue density corssing over the cochlear promontory - enlarged facial nerve canal or separate canal - aplastic or hypoplastic foramen spinosum

Answer 139

severe invasive infection of the EAC which can raidly spread. typically diabetics, immunosuppressed, elderly pseudomonas 98%

Answer 140

this is a thing intrinsic high t1 from methaemoglobin

Answer 141

shingles of the facial nerve, reactiation of VZV otalgia, facial nerve palsy, vesicular eruption invovling the tongue, pinna, EAC identical to Bells with increased enhancement of the facial nerve

Answer 142

typical sites - fundal canalicular - anterior gen - posterior genu rarely other places but shouldnt have it in the meatal segment or extracranial

Answer 143

locally invasive tumours of the endolymphatic sac/duct. assoc with von hippel lindau almost always arise from the vestibular aqueduct involving the sac or duct CT infiltrative or moth eaten erosion central calcific spiculation and posterior rim calcification intense enhancement MR T1 foci of hyper C+ heterogenous T2 heterogenous

Answer 144

rare EAC disease characterised by expansion of the EAC by a plug of desquamated keratin CT well defined soft tissue mass within the EAC diffusely enlarged without erosion

Answer 145

comprise a spectrum of congenital defects that occur in the head and neck result from persistence of branchial cleft or pouch resulting in a cevical anomaly located along the anterior border of the sternocleidomastoid muscle from the tragus of the ear to the clavicle encompass cysts, fistulas and sinuses

Answer 146

First - above the level of the mandible near the EAC within or close to the parotid gland Second - between the mandible angle and the carotid bifurcation - deeper than the platysma and superficial layer of deep cervical fascia - between pharyngeal wall to skin, laterally and inferiorly between ICA and ECA - extension between the ICA and ECA above bifurcation "notch/tail/beak sign" - most common 95%, most common of these is at the angle of the mandible Third - infrahyoid neck - posterior to the common or internal carotid, between the hypoglossal nerve below and glossopharyngeal nerve above - most lie in the posterior cervical space posterior to the sternocleidomastoid - if a sinus can drain to pyriform sinus Fourth - infrahyoid neck usually adjacent to the thyroid gland - can be hard to tell from a third - parallel the course of the recurrent laryngeal nerve - more common on the left - usually form a sinus with apex at the pyriform sinus, like the third, but extend inferiorly to reach anterior left upper thyroid lobe

Answer 147

congenital neck cyst/mass typically midline, can be anywhere from foramen caecum to thyroid gland, though typically infrahyoid minimally complex on US unless infection may have slight rim enhancement can rarely have a papillary carcinoma assoc generally within 2cm of midline usually deep to strap muscles, can be embedded MR T1 variable T2 typically high C+ none if uncomplicated

Answer 148

can be false or true - true: all layers - false: herniating through muscle layer Can be traction or pulsion - traction: secondary to pulling forces on outer oesophagus - pulsion: occurs secondary to increased intraluminal pressure Can be upper, middle or lower Upper - Zenkers - Killian Jamieson Middle - traction diverticula (2nd to fibrosis/inflammation/scarring) - pulsion: secondary to pressure Lower - epiphrenic

Answer 149

a posterior outpouching of the hypopharynx just proximal to the upper oesophageal sphincter through a weakness in the muscle layer called Killian dehiscence/killian triangle

Answer 150

false diverticulum of the upper oesophagus through the killian jameison sapce. just below circopharyngeus, anteriorly and laterally

Answer 151

pulsion diverticula of the lower oesophagus just above the lower oesophageal sphincter more frequently at the right posterolateral wall

Answer 152

cysts that occur within or arise from the thymus can be acquired on congenital congenital - arise from a patent thymopharyngeal duct - contain thymic tyissue - often unilocular - can be cervical aquired - secondary to thoracotomy or following treatment - assoc with thymic tumours - cann be uni or multilocular can be cervical or mediastinal

Answer 153

also known as fay syndrome, characterised by neck pain in the region of the carotid bifurcation aetiology is unclear. elevated inflammatory markjers. typically about the bifurcation mild narrowing of the lumen eccentric wall thickening, enhancement, fat stranding king kong carotid ddx dissection vasculitidies

Answer 154

muscles of mastication mylohyoid anterior digastric tensor tympani/tensor palatini

Answer 155

unilateral tongue atrophy, except for palatoglossus (X)

Answer 156

an uncommon benign b cell lymphoproliferative condition can be unicentric or multicentric (usually HIV)

Answer 157

a rare benign inflammatory disease manifestly as enlargement of the cervical nodes and salivary glands

Answer 158

intrinsic - granulomatous infection - sarcoid - amyloid - castleman - treated lymphoma - occupational lung diseases - rosai dorgman - papillary, bronchogenic, breast, mucinous, osteosarc hypervascular - kaposis - papillary thyroid, NET, RCC - castleman - kimura - kikuchi fujimoto - angioblastic t cell lymphoma

Answer 159

a type of malignant cutaenous primary t cell lymphoma

Answer 160

Anywhere from foramen caecum to thyroid gland typically infrahyoid and within 2cm of midline US usually simple can be complex assoc soft tissue lesion ?papillary ca vs ectpic thyroid CT usually simple rim enhancement can be embedded in the strap muscles MR T1 variable T2 high C+ rim can be

Answer 161

us absent thyroid ct hyperdense soft tissue mass homogenous enhancement MR well defined T1 iso to hyper T2 varibale C+ strong NM tech or iodine scan DDX lingual tonsil thyroglossal duct cyst malignany hamengioma dermoid

Answer 162

Increased stim - hcg secretion - excess TSH secretion - TSH receptor stim ab; graves independant function - functioning adenoma, multinodular goiture Inflammation - autoimmune (hashimotos, post partum) - post viral (de quervins) - infections - iatrogenic Extrathyroid - dietary - neoplasic (mets, pit adenoma, struma ovarii) Iodine exposuire

Answer 163

Primary - autimmune - iodine deficiency - thyroiditis (post partum, subacute, riedel, silent) - post radiation - infiltrative (lymphoma, sarcoid, amyloid, tb) Secondary - pit adenoma - pan hypopit - post radiation - infiltrative Congenital - absent thyroid - ectopic/underdeveloped - dyshormonogenesis drug induced

Answer 164

an autoimmune thyroid disease and most common cuase of thyrotoxicosis caused by ab directed stimulation of the TSH receptor with increased prod and release to t3 and t4

Answer 165

US enlarged hyperechoic heterogenous absence of nodularity hypervascular (thyroid inferno) NM I123 homogeneously increased uptake T99m homogeneously increased uptake pyraimydal lobe Thyroid dermopathy/acropachy Graves ophthalmopathy exophthalmos/palps/goitre = merseburger triad

Answer 166

almost always assoc with ophthalmopathy xr symm hands and feet invovlement tubular bones prominent smooth flowing periosteal reaction soft tissue swelling

Answer 167

enlarged muscles sparing of the musculotendinous junction coke bottle LPS - IR - MR - SR - LR - Obliques exophthalmos - 1cm to posterior sclera - 2cm to anterior globe - interzygomatic line

Answer 168

pseudotumour sarcoid lymphoma mets amyloid erdheim chester

Answer 169

a subtype of autoimmune thyroiditis usually presents with hypo and a goitre can present with hyper anti tg antibodies, tpo

Answer 170

enlarged thyroid, can be atrophic later heterogenous hypoechoic micronodules with surrounding echogenic septations (pseudonodular/giraffe) usually normal or decreased flow but can be hypervasc prominent reactive cervical nodes NM early increased late spots of reduced uptake

Answer 171

rare. usually non hodgkins. assoc with hashimotos. imaging similar to primary thyroid malignancies and hashimotos US nodular diffuse mixed calcs are uncommon CT goitre hypoattenuating hterogenous enahncement MR t1/t2 iso to hyper

Answer 172

non toxic simple graves mng hashimotos thyroid cancer drugs/diet depositional eg amyloid misc; plummer vinson

Answer 173

a rare form of autoimmune thyroiditis, sometimes considerted a manifestation of igG4 disease stony or woody assoc - retroperitoneal fibrosis - sclerosing fibrosis - orbital pseudotumour - fibrosing mediastinitis imaging US - homogenously hypoechoic with poor demarcation fo the gland borders CT compression of lcoal structures by an enlarged thyroid with low attenuation change areas within MR low on T1 and t2

Answer 174

a form of self limiting subacute thyroiditis usually preceded by an upper respiratory tract infection hyper followed by hypo symptoms followed by euthyroid US poorly defined regions of decreased echos decreased vasc in areas NM low uptake in a patient with hyperthyroidism

Answer 175

thin peripheral halo predominantly cystic or mixed isoechoic or anechoic homogenous or hetero absence of internal flow

Answer 176

US solitary mass irregular outline small punctate microcalcifications nodes can cavitate, have septa, mural nodules CT nodes have - cystic components - thick nodular walls - septa - sometimes calc - sometimes purely cystic MR can have cystic bits solid bits enhance variable t2 NM concentrates radioiodine but not pertechnetate FDG avid

Answer 177

typically hypoechoic lacks cystic change concentrates pertechnetate but not radioiodine

Answer 178

sporadic or familial - MEN 2a/b - VHL - NF1 US - punctate foci of calc in primary and nodes CT irregular dense calcific foci NM do not concentrate radioiodine FDG avid mets concentrates thallium

Answer 179

US microcalc usually infiltrative CT nodes infiltrative primary NM no radioiodine uptake

Answer 180

Assoc: - MEN 1 - MEN 2a - familial hypocalciuric hypercalcaemia - familial isolated primary hyperparathyroidism - hyperparathyroidism jaw tumour syndrome Primary - parathyroid adenoma - parathyroid hyperplasia - parathyroid cacinoma - parathyromatosis Secondary - caused by chronic hypocalc with renal osteodystrophy (or malnurtriton, or vit d def) - results in parathyroid hyperplasia Tertiary - autonomous parathyroid adenoma caused by chronic overstimualtion of hyperplasitc gflands in renal insufficicency

Answer 181

Subperiosteal bone resorption - radial middle phalanges - medial long bones - lamina dura Subchondral resorption - clavs, PS, SIJ Subligamentous resoprtion - ischial tube - trochanters - inferior calcaneus and calvicle Intracortical resorption Terminal tuft erosion Rugger jersey Osteopaenia Brown tumours Salt and pepper skull Chondrocalcinosis Renal osteodystrophy/osteomalacia vit d - osteopaenia - subperiosteal resorption - rugger jersey spine - soft tissue calc - superscan - rib notching

Answer 182

Typically juxtathyroidal Ectopic - mediastinum - retropharyngeal - carotid sheath - intrathyroidal US - homogenously hyopechoic - echogenic capsule - can show a feeding vessel on doppler Tc99m sestamibi uptake CT intense arterial enchancement washout on delayed low attenuation on nc polar vessel sign variable MR findings

Answer 183

Primary - sporadic - familial MEN 1 and 2a Secondary - renal failure tv99m mibi

Answer 184

invasiveness calcifications heterogeneity lobulated morph larger negative predictors - absence of suspicious vascularity - absent thick capsule - homogenity of capsule

Answer 185

iatrogenic congenital absence familial idiopathic pseudo - abnormal end organ resistance pseudopseudo - similar to pseudo without alterations in pth levels and calc metabolism

Answer 186

MSK - focal and generalised osteosclerosis - dense metaphyseal bands - skull vault thickening - subcut calc - DISH CNS - intracranial calc - cataracts

Answer 187

MSK - short stature - brachydactyly - soft tissue calc - exostoses - broad bones with coned epiphyses CNS - BG calc - sclerochoroidal calc - deep white matter calc

Answer 188

pituitary adenoma islet cell tumours of the pancreas parathyroid proliferative diseases PiParPanc

Answer 189

Phaeochromocytoma Medullary thyroid cancer Parathyroid hyperplasia PMP

Answer 190

phaeochromocytoma medullary thyroid marfanoid mucosal neuroma/ganglioneuroma PMMM

Answer 191

deep (within orbit) or superifical (adjacent to orbital rim) most commonly upper outer quadrant usually extraconal, non enhancing smooth margins cystic/solid components heterogenous with internal fat

Answer 192

a rare cause of an orbital mass can be congenital or acquired most commonly affect the eyelid but can be truly intraorbital

Answer 193

Rhegmatogenous Non rhegmatogenous - retinal break - lattice degeneration - tractional - exudative Rhegmatogenous - posterior vitreous detachment - trauma Tractional - Diabetic retinopathy - sickle cell retinopathy - retinopathy of prematurity Exudative - central serous chorioretinopathy - vogt koyanagi harada disease - coats disease - choroidal neoplasms

Answer 194

US - bright continuous and folded membrane within the vitreous - freely moving/aftermovement - less mobile than posterior vitreous detachment CT - folded membranes within subretinal space - limited anteriorly by the ora serrata - posteriorly converges on the optic disc

Answer 195

trauma surgery spontaneous medications for lower iop hypertension neoplastic inflammatory choroidal disordrs caroticocavernous fistula severe atherosclerosis

HEAD AND NECK Flashcards

(219 cards)