Head and Neck Imaging

Question 1

Enhancing orbital mass

Answer 1

cavernous haemangioma (slow flow cavernous venous malformation): most common adult orbital mass, non-distensible, non-neoplastic, progressive enhancement, marginal chemical shift
infantile haemangioma: most common infantile, vascular neoplasm with flow voids

Lymphatic malformation: multilocular cysic hamartoma with fluid-fluid levels. Septal enhancement.

Orbital venous varix: enlarges on valsalva, can haemorrhage

Metastases, Lymphoma, Nerve sheath tumour

Optic nerve: neuritis/glioma/meningioma
Lacrimal gland: salivary epithelium-pleiomorphic adenoma/adenoid cystic/mucoepidermoid, lymphatic - lymphoma/sarcoid, inflammatory - pseudotumour

Question 2

Orbital rim fracture

Answer 2

orbital wall blowout: rim intact, floor most common
ZMC: zygomatic arch, inferior and lateral orbital margin
LeForte: 1: floating palate, 2: floating maxilla, 3: craniofacial dissociation

Question 3

Cavernous sinus mass/enhancement

Answer 3

Macroadenoma
Meningioma: compress carotid, dural tail, hyperdense, t2 hyperintense
Schwannoma or perineural spread
Talosa-Hunt
Carotid-cavernous fistula

Question 4

Aggressive sinus disease with bony destruction

Answer 4

Invasive fungal sinusitis: can be T1/T2 hypointense
Granulomatous disease: Wegener/sarcoid
Sinonasal carcinoma (90% SCC>SNUC/adenocarcinoma/rhabdomyosarcoma)
Lymphoma
Cocaine

Question 5

Unilateral parotid mass

Answer 5

Salivary gland neoplasm: 80% benign - 80% pleiomorphic adenoma/Warthin. Malignant: Adenoid cystic/mucoepidermoid carcinoma (more common in parotid)
Lymphadenopathy
Branchial cleft cyst

Question 6

Bilateral parotid masses

Answer 6

Benign lymphoepithelial lesions (cystic/solid/mixed)
lymphadenopathy: lymphoma, head and neck SCC or skin melanoma/SCC
Sjogrens: risk of lymphoma
Warthin tumours
Sarcoid

Question 7

Orbital extraocular muscle enlargement

Answer 7

pseudotumour: pain, often unilateral, LR
thyroid eye disease: IM SLO, spares myotendinous junction
lymphoma
rhabdomyosarcoma in children
sarcoidosis/Wegeners
vascular congestion

Question 8

Pharyngeal mucosal mass

Answer 8

SCC: often obstruct the eustacian tube at the fossa of Rosenmuller
Lymphoma
Infection/abscess
Tornwaldt cyst
Minor salivary gland tumour

Question 9

Masticator space mass

Answer 9

Abscess
Rhabdomyosarcoma/Chondrosarcoma/osyteosarcoma/Ewing sarcoma
Nerve sheath tumour
Venolymphatic malformation

Question 10

Carotid space mass

Answer 10

Paraganglioma
Nerve sheath tumour
Vascular mass/anomaly
Lymphadenopathy

Question 11

Retropharyngeal mass

Answer 11

Abscess
Nodal metastasis
Lymphoma
Venolymphatic malformation

Question 12

Clival Mass

Answer 12

Chordoma
Chondrosarcoma
Metastasis
Invasive macroadenoma
Plasmacytoma
meningioma

Question 13

Vascular Neck injury

Answer 13

Dissection
Pseudoaneurysm
Occlusion
AVF

Question 14

Globe lesion in a child

Answer 14

RB: 95% calcify, hyperdense, T1 bright, t2 dark
PHPV: does not calcify, small eye
Coats disease: does not calcify
ROP: small eye

Question 15

Optic nerve enlargement/enhancement

Answer 15

optic neuritis - demyelination/toxic or metabolic/ischaemic - 50% get MS
optic nerve glioma - bilateral in NF1
meningioma - tram track post contrast, 25% calcify
lymphoma
sarcoidosis

Question 16

Pachymeningeal enhancement

Answer 16

Intracranial hypotension
Metastases
Sarcoidosis
Pachymeningitis - Tb
Subdural haematoma

Question 17

Middle ear mass

Answer 17

glomus tympanicum
acquired cholesteatoma
aberrant ICa
facial nerve schwannoma
cholesterol granuloma

Question 18

Base of tongue mass in child

Answer 18

Thyroglossal duct cyst - most common congenital cystic neck lesion
lingual thyroid
Epidermoid/dermoid cyst

Question 19

Facial nerve enhancement

Answer 19

Normal - ok to enhance after the genu
Nerve sheath tumour
Ramsay Hunt/Bells palsy
Perineural spread

Question 20

Floor of mouth mass

Answer 20

Ranula
Abscess
Venolymphatic malformation
Sialadenitis
SCC
Dermoid/epidermoid

Question 21

Aggressive nasal mass in child/adolescent

Answer 21

JNA
ENB
Rhabdomyosarcoma
Lymphoma
inverted papilloma

Question 22

Cystic neck mass

Answer 22

"congenital cyst": Branchial cleft cyst
Thymic cyst
thyroglossal duct cyst
abscess
Lymphatic malformation
Cystic SCC/papillary thyroid metastasis

Question 23

Jugular foramen mass

Answer 23

Glomus jugulare
Nerve sheath tumour
Meningioma
Metastasis

Question 24

Petrous apex mass

Answer 24

congenital cholesteatoma DWI
cholesterol granuloma T1 bright
petrous apicitis
asymmetric marrow
mucocoele
Malignancy: metastasis/chondrosarcoma/myeloma

Question 25

Leptomeningeal enhancement

Answer 25

Metastases
Sarcoid
Tb
Meningitis
Subacute infarction
Collateral flow in moyamoya/vasculitis