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PART 2 > HEAD AND NECK > Flashcards

HEAD AND NECK Flashcards

1
Q

Tonsilitis imaging and complications

A

tonsilar enlargement, touching in the midline
contrast enhancing without focal fluid
parapharyngeal fat stranding

complications
- peritonsillar abscess
- intratonsillar abscess
- extension to deep spaces
- otitis media

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2
Q

Tonsilitis ddx

A

SCC
Lymphoma

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3
Q

Tonsillar abscess imaging

A

central hypoattenuation and rim enhancement
tonsillar tissue surrounding

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4
Q

Peritonsillar abscess imaging

A

rim enhancing fluid adjacent to enlarged and inflamed tonsil

complications;
- retropharyngeal effusion
- retropharyngeal abscess
- lemierre syndrome (septic thrombophlebitis IJV)

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5
Q

Lemierre syndrome is

A

thrombophlebitis of the IJC with distant sepsis in the setting of intial oropharyngeal infection (pharyngitis, tonsilllitis, peritonsilar abscess, retropharyngeal abscess).

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6
Q

Retropharyngeal abscess is (and causes)

A

potentially life threating infection involving the retropharyngeal space.

causes
- complication of primary infection elsewhere such as nasopharync, paranasal sinuses, middle ear
- or oropharyngeal infections, discitis, osteomyelitis, penetrating trauma

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7
Q

Retropharyngeal abscess complications

A
  • posterior extension to prevert, disc/vert, epidural
  • lateral extension to carotid and jugular
  • anteiror compression airway
  • inferior extension to mediastinum
    sepsis
  • grisel syndroime
  • lemierre synrome
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8
Q

Retropharyngeral abscess ddx

A

retropharyngeal cellulitis
retropharyngeal oedema
prevertebral abscess
retropharyngeal haematoma
acute calcific prevertebral tendiintis
pseudothickening

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9
Q

Grisel syndrome is

A

torticollis of the atlantooaxial joint from inflammatory ligamentous laxity in head and neck infection

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10
Q

Zenker diverticulum is

A

posterior outpouch of the hypopharynx, proximal to the upper oesophageal sphincter through a weakness in the muscle layer called killian dehiscence (normal cleavage plane between the two parts of the inferior constrictor)

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11
Q

zenkers imaging

A

midline posterior diverticulum at C5/C6
may be transient

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12
Q

Killian Jameison diverticulum is

A

an outpouching of mucosa through the killian jamieson space.

located below cricopharyngeus, anteriorly and laterally. typically left sided, can be bilateral. smaller, less frequent and normally asx compared to zenkys

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13
Q

Head and neck SCC pathophysiology

A

HPV important risk factor, particularly 16, 18, 31
Stronger assoc in some sites, eg. oropharynx
Overexpression of p16 used as surrogate marker

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14
Q

Oral cavity SCC staging

A

TX cant see
Tis

T1
- <2cm greatest dimension, DOI <5mm

T2
- <2cm DOI 5-10mm OR
- 2-4cm DOI <10mm

T3
- DOI >10mm, or
- tumour >4cm DOI <10mm

T4a moderately advanced
- >4cm DOI >10mm OR
- invades local structures

T4b very advanced
- invades masticator space, pterygoid plates, skull cases and/or encases ICA

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15
Q

Oral cavity SCC ddx

A

other malig
- lymphoma
- minor salivary gland
- sarcoma

infection
- teeth
- infected rannula

radionecrosis mandible

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16
Q

Cervical node staging

A

NX

N0

N1
- single ipsilateral node <3cm no ENE

N2a
- single ipsi 3-6cm, no ENE
N2b
- multiple ipsi, <6cm, no ENE
N2c
- bilateral or contralatertal nodes <6cm, no ENE

N3a
- node >6cm, no ENE
N3b
- node with clinically overt ENE

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17
Q

Oral cavity SCC usually in

A

lower lip, oral tongue, FOM

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18
Q

Oropharyngeal SCC overview

A

subcatergorised into HPV/P16 positive or negative. P16 associted occurs in younger but responds better to chemoradiotherapy and carry a better prognosis

location; tonsil, base of tongue, soft palate
although can be anywhere
nb; lingual surface epiglottis coiunts as larynx, soft plate nasopharynx

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19
Q

P16 negative oropharyngeal SCC staging

A

Tx
Tis

T1
- <2cm

T2
- 2-4cm

T3
- > 4cm or
- extension to lingula surface epiglottis

T4a moderate
- larynx
- extrinsix tongue mm
- medial pterygoid
- hard palate
- mandible

T4b very advanced - ICA or any of the following
- lateral pterygoid
- pterygoid plates
- lateral nasopharynx
- skull base

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20
Q

P16 postive oropharyngeal SCC staging

A

T0

T1
- <2cm

T2
- 2-4 cm

T3
- >4cm OR
- extension to lingual surface epiglottis

T4
- larynx, except lingual epiglottis
- extrinsic mm tongue
- medial pterygoid
- hard palate
- mandible

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21
Q

Hypopharyngeal SCC path

A

bad for you - worst proggy of all

most commonly at piriform sinus, but can be posterior wall or post cricoid/pharyngooesopahgeal junction

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22
Q

Hypopharynx SCC staging

A

TX
TIS

T1
- one subsite AND/OR
- <2cm

T2
- extends into adjacent subsite or site AND/OR
- 2-4cm with hemilarynx fixation

T3
- tumour >4cm OR
- clinical fixation hemilarynx OR
- extension to oesophageal mucosa

T4a moderate
- thyroid cartilage
- cricoid cartilage
- hyoid bone
- thyroid gland
- oesophageal muscle
- central compartment soft tissue

T4b
- encases carotid artery OR
- mediastinum/prevertebral

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23
Q

Nasopharyngeal carcinoma path

A

of squamous origin
some types strongly assoc with EBV

types
- keratinising
- non keratinising
- basaloid squamous

non kerat and basaloid squamous assoc with EBV

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24
Q

NPC imaging

A

Fossa or rosemuller ionitially effaces
Level 2 and 5 nodes commonly involved

CT
- soft tissue mass fossa of rosenmuller
- smaller confined by pharyngobasilar fascia
- larger can extend in any direction
- heterogenous enhancement

MR
T1 iso to muscle
T2 iso to hyper to muscle, fluid in middle ear
C+ heterogenous prominent. ?perineural invasion

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25
Q

NPC ddx

A

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

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26
Q

NPC staging

A

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

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27
Q

Larynx SCC staging

A

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

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28
Q

Ranula is a

A

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

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29
Q

Ranula imaging

A

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

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30
Q

Cricopharyngeal spasm is (and imaging and complications)

A

may present as a cause of dysphagia

presents as a cricopharyngeal bar at C5/6 on fluoro

complcations
- hypertrophy
- zenkers

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31
Q

Vocal cord paresis causes and imaging

A

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

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32
Q

Subglottic/tracheal stenosis

A

Post intubation

Sparing posterior wall
- Relapsing polychondritis (smooth)
- Tracheobronchiopathia osteochondroplastic (nodular)

Involving posterior wall
- amyloid
- wegners
- sarcoid

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33
Q

Relapsing polychondritis is

A

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

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34
Q

Tracheobronchopathia osteochondroplastica is

A

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

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35
Q

Acute sinusitis imaging

A

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

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36
Q

Chronic sinusitis imaging

A

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

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37
Q

Concha bullosa is

A

pneumatisation of the middle turbinate, commonly assoc with septal deviation

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38
Q

Paradoxical middle turbinate is

A

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

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39
Q

Agger nasi cells are

A

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

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40
Q

Supraorbital cells are

A

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

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41
Q

Sphenoethmoidal air cell/Onodi air cell

A

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.

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42
Q

Haller cells are

A

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

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43
Q

Fungal sinusitis classification

A

Non invasive; hypae do not invade mucosa
- allergic fungal
- sinus fungal mycetoma

Invasive; hypae in mucosa and beyond
- acute invasive
- chronic invasive
- granulomatous invasive

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44
Q

Allergic fungal sinusitis imaging and ddx

A

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

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45
Q

Paransal sinus mycetoma imaging

A

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

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46
Q

Acute invasive fungal sinusitis is

A

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

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47
Q

Acute invasive fungal sinusitis imaging

A

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

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48
Q

Chronic invasive fungal sinusitis imaging

A

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

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49
Q

Granulomatous invasive fungal sinusitis is

A

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

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50
Q

Granulomatosis with polyangitis is

A

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

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51
Q

Granulomatosis with polyangitis upper resp features

A

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

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52
Q

Sinonasal polyposis is

A

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

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53
Q

Sinonasal polyposis imaging and grading

A

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

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54
Q

Antrochoanal polyps are

A

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

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55
Q

Antrochoanal polyp imaging

A

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

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56
Q

Inverted papillomas are

A

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

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57
Q

Inverted papilloma imaging

A

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

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58
Q

Juvenile nasal angiofibroma is

A

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.

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59
Q

Juvenile nasal angiofibroma imaging

A

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

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60
Q

Juvenile nasal angiofibroma staging

A

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

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61
Q

Tornwaldt cyst is

A

a common incidental benign nasopharyngeal mucosal cyst

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62
Q

Tornwaldt cyst imaging

A

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

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63
Q

Paranasal sinus mucocele is

A

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

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64
Q

Paranasal sinus mucocele imaging

A

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

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65
Q

Sinonasal undifferentiated carcinoma is

A

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

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66
Q

Sinonasal undifferentiated carcinoma imaging

A

Ethmoid/superior nasal cavity
Bone destruction

CT: enhances to variable degree

MR
T1 iso to muslce
T2 iso to hyper to muscle
C+ heterogenous

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67
Q

Olfactory neuroblastoma/esthesioneuroblastoma is

A

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.

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68
Q

Olfactory neuroblastoma/esthesioneuroblastoma imaging

A

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

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69
Q

Olfactory neuroblastoma/esthesioneuroblastoma ddx

A

Olfactory neuroepithelioma

Olfactory groove meningioma

Sinonasal carcinoma
- lack peritumoural cysts

Rhabdo

NPC
- more posterior, older

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70
Q

Olfactory neuroblastoma/esthesioneuroblastoma stagign

A

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

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71
Q

Sinonasal adenocarcinomas are

A

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

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72
Q

Sinonasal adenocarcinoma imaging

A

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

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73
Q

Paranasal sinus osteoma imaging

A

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

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74
Q

Encephalocoeles are

A

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

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75
Q

Sinonasal mucosal melanoma is

A

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

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76
Q

Sinonasal mucosal melanoma imaging

A

CT
polypoid or mass like
bone remodelling or erosion
strongly enhancing

MR
T1 homogenoeus,can be high
T2 low
C+ moderate enhancement

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77
Q

Sinonasal lymphoma is

A

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

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78
Q

Sinonasal lymohoma imaging

A

can be discrete or diffusely infiltrating

CT
soft tissue attenuating
can have bone destruction

MR
T1 intermediate
T2 hypointense
C+ typically homogenous

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79
Q

Rhinoscleroma is

A

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

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80
Q

Rhinoscleroma imaging

A

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

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81
Q

Head and neck rhabdomyosarcoma general path

A

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

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82
Q

Head and neck rhabdomyosarcoma imaging

A

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

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83
Q

Le fort 1

A

horizontal maxillary fracture
floating teeth

passes through
- alveolar ridge
- lateral nose
- inferior wall maxillary sinus
- pterygoid plates

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84
Q

Le fort 2

A

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

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85
Q

Le fort 3

A

craniofacial disjunction
floating face

transverse line through
- nasofrontal suture
- maxillofrontal suture
- orbital wall
- zygomatic arch/zygomaticofrontal suture
- pterygoid plates

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86
Q

Le fort practical points

A

Pterygoid plates

Type 1 - anterolateral margin nasal fossa

Type 2 - inferior orbital rim

Type 3 - zygomatic arch

Nasofrontal suture means type 2 or 3

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87
Q

Zygomaticomaxillary complex fractures comprise fractures of the

A

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

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88
Q

Nasoorbitoethmoid (NOE) complex fractures are

A

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

89
Q

Sialadenitis is, causes and associ

A

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

90
Q

Sialadenitis imaging

A

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

91
Q

Sialolithiasis location

A

almost always submandibvular wharton duct
then parotid duct

92
Q

Pleomorphic adenoma is

A

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

93
Q

Pleomorphic adenoma location

A

80% parotid
10% SMG
minor 6%
sublingual 1%

also commonly found in lacrimal gland

94
Q

Pleomorphic adenoma imaging

A

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

95
Q

Pleomorphic adenoma ddx

A

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

96
Q

Warthin tumours are

A

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

97
Q

Warthin tumour imaging

A

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

98
Q

Salivary gland tumours useful tips

A

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

99
Q

Mucoepidermoid carcinoma of salivary glands are

A

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

100
Q

Mucoepidermoid carcinoma of salivary glands imaging

A

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

101
Q

Adenoid cystic carcinomas are

A

second most common malig ofthe minor salivary glands behind mucoepidermoid

locally aggressive with propensity for perineural spread

102
Q

Adenoid cystic carcinoma imaging

A

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

103
Q

HIV assoc salivary gland disease is

A

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

104
Q

HIV assoc salivary gland disease imaging

A

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

105
Q

Supernumery teeth assoc

A

Cleidocranial dysostosis
Gardner syndrome
Cleft palate

106
Q

Mesiodens is

A

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

107
Q

Mesiodens complications

A

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

108
Q

Periapical radiolucency ddx

A

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

109
Q

Periapical cysts are

A

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

110
Q

Periapical granuloma is

A

a mass like region of granulation tissue in relation to teeth infection

tend to be higher attenuating than periapical cysts

111
Q

Periapical abscess is

A

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

112
Q

Periapical abscess imaging and complications

A

Imaging
- well defined lucency
- adjacent caries
- adjacent empty socket

Complications
- OM
- CNS infection
- ludwig angina
- deep space infection
- sinusitis

113
Q

TMJ dislocation typwa

A

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

114
Q

TMJ anatomy quick recap

A

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

115
Q

TMJ normal appearance

A

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

116
Q

TMJ dysfunction imaging

A

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

117
Q

Mandibular osteoradionecrosis is

A

osteonecrosis following radiation therapy due to its superficial position.

imaging
- cortical destruction
- sequestration
- absence of a soft tissue mass

118
Q

Medication related osteonecrosis of the jaw is (drugs and imaging)

A

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

119
Q

Nasolabial cysts are

A

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

120
Q

Nasolabial cyst imaging

A

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

121
Q

Incisive canal cysts are

A

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

122
Q

Dentigerous cysts are

A

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

123
Q

Dentigerous cyst imaging

A

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

124
Q

Stafne cyst is

A

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

125
Q

Temporomandibular joint inflammation causes

A

RA
Ank spond
CPPD
Gout
Psoriatic arthritis
SLE
JIA

126
Q

Odontogenic keratocyst (OKC) are

A

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

127
Q

Odontogenic keratocyst imaging

A

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

128
Q

Ameloblastoma is

A

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

129
Q

Ameloblastoma imaging

A

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

130
Q

Odontomas are

A

most common odontogenic tumours of themmandible

assoc with gardner syndrome

131
Q

Odontoma imaging

A

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

132
Q

Aberrant internal carotid artery is

A

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

133
Q

Aberrant ICA imaging and ddx

A

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

134
Q

Temporal bone fracture breakdown and complications

A

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

135
Q

Acute otomastoiditis imaging

A

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

136
Q

Bezold abscess is

A

complication of otomastoiditis
deep to scm

137
Q

Citelli abscess is

A

complication of otomastoiditis
abscess in digastric triangle

(or OM of occipital bone, same name)

138
Q

Acute otomastoiditis complications

A

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

139
Q

Petrous apicitis clinical presentation

A

Otomastoiditis symptoms and

  • deep facial pain due to meckels cave inflammation
  • abducens nerve palsy (gradenigo syndrome) inflammation of dorellos canal
140
Q

Cholesteatoma general types

A

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

141
Q

Cholesteatoma important features to report

A

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

142
Q

Sinus tympani is

A

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

143
Q

Congenital cholesteatoma imaging

A

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

144
Q

Acquired cholesteatoma path and complications

A

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

145
Q

Acquired cholesteatoma imaging

A

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

146
Q

Acquired cholesteatoma ddx

A

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

147
Q

External auditory canal atresia imaging and associations

A

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

148
Q

Dehiscent jugular bulb is

A

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

149
Q

Semicircular canal dehiscence clinical

A

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

Posterior
- mostly hearing

150
Q

Large endolymphatic duct and sac syndrome imaging and associations

A

Assoc
- pendred syndrome
- vestibular anomalies
- cochlear anomalies
- semicircular canal anomalies

Imaging
- enlarged vestibular aqueduct >1.5mm at the midpoint (valvassori)
- opercular width >2mm (Cincinnati)

151
Q

Petrous apex mucocele iamging

A

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

152
Q

Labyrinthitis ossificans is

A

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

153
Q

Labyrinthitis ossificans imaging

A

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

154
Q

Otosclerosis is

A

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

155
Q

Otosclerosis imaging

A

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

156
Q

Otosclerosis grading

A

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

157
Q

Cholesterol granuloma is

A

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

158
Q

Choleterol granuloma imaging

A

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

159
Q

Cholesterol granuloma ddx

A

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

160
Q

Cochlear implant assessment

A

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

161
Q

Inner ear malformations classification

A

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
162
Q

Persistent stapedial artery is

A

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

163
Q

Necrotising otitis externa is

A

severe invasive infection of the EAC which can raidly spread.

typically diabetics, immunosuppressed, elderly

pseudomonas 98%

164
Q

Intralabyrinthine haemorrhage

A

this is a thing
intrinsic high t1 from methaemoglobin

165
Q

Ramsay hunt syndrome is and imaging

A

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

166
Q

Normal facial nerve enhancement

A

typical sites
- fundal canalicular
- anterior gen
- posterior genu

rarely other places but shouldnt have it in the meatal segment or extracranial

167
Q

Endolymphatic sac tumours are and imaging

A

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

168
Q

Keratosis obturns is and imaging

A

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

169
Q

Branchial cleft anomalies

A

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

170
Q

Types/locations of branchial cleft anomalies

A

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

171
Q

Thyroglossal duct cyst is and imaging

A

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

172
Q

Oesophageal diverticula classification

A

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

173
Q

Zenkers diverticulum is

A

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

174
Q

Killiam Jameison diverticulum is

A

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

175
Q

Epiphrenic diverticulum are

A

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

176
Q

Thymic cysts are

A

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

177
Q

Carotidynia is

A

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

178
Q

trigeminal nerve denervation

A

muscles of mastication
mylohyoid
anterior digastric
tensor tympani/tensor palatini

179
Q

hypoglossal nerve denervation

A

unilateral tongue atrophy, except for palatoglossus (X)

180
Q

Castleman disease is

A

an uncommon benign b cell lymphoproliferative condition

can be unicentric or multicentric (usually HIV)

181
Q

Kimura disease is

A

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

182
Q

high attenuating nodes

A

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

183
Q

mycosis fungoides is

A

a type of malignant cutaenous primary t cell lymphoma

184
Q

Thyroglossal duct cyst imaging

A

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

185
Q

Lingual thyroid imaging and ddx

A

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

186
Q

Hyperthyroidism causes

A

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

187
Q

Hypothyroidism causes

A

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

188
Q

Graves disease is

A

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

189
Q

Graves disease imaging

A

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

190
Q

Thyroid acropachy imaging

A

almost always assoc with ophthalmopathy

xr
symm hands and feet invovlement
tubular bones
prominent smooth flowing periosteal reaction
soft tissue swelling

191
Q

Graves orbitopathy imaging

A

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

192
Q

Graves orbitopathy ddx

A

pseudotumour
sarcoid
lymphoma
mets
amyloid
erdheim chester

193
Q

Hashimotos thyroiditis is

A

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

194
Q

Hashimotos imaging

A

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

195
Q

Thyroid lymphoma is/imaging

A

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

196
Q

Goitre causes

A

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

197
Q

Riedels thyroiditis is/imaging

A

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

198
Q

De quervains thyroiditis is/imaging

A

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

199
Q

Follicular adenoma imaging

A

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

200
Q

Papillary thyroid cancer imaging

A

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

201
Q

Follicular thyroid carcinoma imaging

A

typically hypoechoic
lacks cystic change
concentrates pertechnetate but not radioiodine

202
Q

Medullary thyroid carcinoma imaging

A

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

203
Q

Anaplastic thyroid carcinoma imaging

A

US
microcalc
usually infiltrative

CT
nodes
infiltrative primary

NM
no radioiodine uptake

204
Q

Hyperparathyroidism assoc and subtypes

A

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

205
Q

Hyperparathyroidism imaging

A

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

206
Q

Parathyroid adenoma imaging

A

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

207
Q

Parathyroid hyperplasia aetiology

A

Primary
- sporadic
- familial MEN 1 and 2a

Secondary
- renal failure

tv99m mibi

208
Q

Parathyroid carcinoma imaging

A

invasiveness
calcifications
heterogeneity
lobulated morph
larger

negative predictors
- absence of suspicious vascularity
- absent thick capsule
- homogenity of capsule

209
Q

Hypoparathyroidism causes

A

iatrogenic
congenital absence
familial
idiopathic

pseudo
- abnormal end organ resistance
pseudopseudo
- similar to pseudo without alterations in pth levels and calc metabolism

210
Q

Hypoparathyroidism imaging

A

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

CNS
- intracranial calc
- cataracts

211
Q

Pseudohypoparathyroidism imaging

A

MSK
- short stature
- brachydactyly
- soft tissue calc
- exostoses
- broad bones with coned epiphyses

CNS
- BG calc
- sclerochoroidal calc
- deep white matter calc

212
Q

MEN 1

A

pituitary adenoma
islet cell tumours of the pancreas
parathyroid proliferative diseases

PiParPanc

213
Q

MEN 2a

A

Phaeochromocytoma
Medullary thyroid cancer
Parathyroid hyperplasia

PMP

214
Q

MEN 2b

A

phaeochromocytoma
medullary thyroid
marfanoid
mucosal neuroma/ganglioneuroma

PMMM

215
Q

Orbital dermoid imaging

A

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

216
Q

Orbital epidermoid is

A

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

217
Q

Retinal detachment types and aetiology

A

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

218
Q

Retinal detachment imaging

A

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

219
Q

Choroidal detachment aetiology

A

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

PART 2 (11 decks)

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