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Head and Neck > Imaging of the Head and Neck > Flashcards

Imaging of the Head and Neck Flashcards

1
Q

4 ways of imaging H&N

A

Radiographs
US
CT
MRI

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2
Q

Benefits of X-ray

A

Quick
Cheap
Readily available
Low ionising radiation dose

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3
Q

How do radiographs work?

A

X-ray beams onto a plate detector with pt between

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4
Q

Negatives of radiographs

A

Low contrast - cannot see things in as much detail/as many things
2D

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5
Q

What is US?

A

Handheld probe using soundwaves

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6
Q

Benefits of US

A

Cheap
No ionising radiation

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7
Q

Negatives of US

A

Operator dependent
Limited by bone - cannot see structures through bone when using US

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8
Q

What is US useful for?

A

Thyroid and superficial soft tissue only

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9
Q

CT how does it work?

A

X-ray beans passing through a donut shaped scanner

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10
Q

Benefits of CT

A

Quick
Readily available

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11
Q

Negatives of CT

A

High radiation dose - not needed for minor injuries

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12
Q

MRI how does it work?

A

Images acquired from a magnet, tunnel shaped

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13
Q

Positives MRI

A

Best contrast - can see lots of structures
No ionising radiation

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14
Q

Problem with MRI

A

Slow
Expensive
Limited availability

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15
Q

What are radiographs commonly used for?

A

Minor skull trauma - that doesn’t meet NICE guidelines for CT
Cervical spine trauma
Foreign bodies in neck - but need to be denser than soft tissue to show up

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16
Q

Uses of US

A

Thyroid evaluation
Superifical head and neck masses - lymph nodes
Superficial infection (eg abscess superficial)
Carotid doppler - see flow through vessel

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17
Q

Uses for CT

A

Trauma - if meet NICE guidelines
Acute focal neurological symptoms - particularly when evaluating haemorrhagic strokes
Malignancy - for mets in neck nodes, but not for non-melanoma staging
Infection - deeper
Angiographic imaging of arteries and veins

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18
Q

NICE criteria for CT

A

GCS less 13 or 15 after 2 hours
Suspected open/depressed skull fracture
Any sign of basal skull fracture - panda eyes, CSF from ears or nose, battles sign
Post trauma seizure
More than 1 vomitting episode
Focal neurological deficit

Loss of consciousness/anmesia since injury +:
>65
history of bleeding/clotting disorders
Dangerous injury
Warfarin treatment

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19
Q

Uses for MRI

A

Best imaging for brain so tumour evaluation, epilepsy
Cervical spinal cord trauma
Head and neck tumours

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20
Q

3 orientations of radiographs

A

Frontal - front on
Lateral - side
Oblique - at angle

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21
Q

3 cross sectional orientations of CT

A

Axial - chop head off
Coronal - crown
Saggital - front to back slice

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22
Q

Normal anatomical position

A

Supine hands - palms to anterior

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23
Q

What do we look for on radiographs?

A

Skull fractures - these are SHARP straight lines / depressions
Pneumocranium - air in skull
Fluid level - infection/haemorrhage?
Lytic soft tissue - mets/melanoma (holes in bone)

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24
Q

What to remember when looking for fractures on skull?

A

REMEMBER SUTURES - these are more jagged

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25
Q

Sutures on skul

A

Coronal
Sagittal

Lambdoid (back of head, triangle shape one each side)
Squamous suture - seperating parietal, temporal occipital and sphenoid

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26
Q

What else appears as lines on skull radiograph?

A

Vascular impressions - normal

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27
Q

What sutures can you see on lateral radiograph?

A

Squamous
Lambdoid
Coronal

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28
Q

What sutures can you see on frontal radiograph?

A

Squamous suture
Coronal suture
Frontozygomatic suture

29
Q

What sutures can you see of superior view of skull?

A

Coronal
Sagittal
Lambdoid

30
Q

What pathology can you potentially see on facial radiograph?

A

Tripod fracture
Black eyebrow = Gas in orbit
TMJ dislocation
Mandible fracture
Fluid in sinuses - eg maxillary sinus, frontal or ethmoidal

31
Q

Normal angulation to take facial radiograph at to view structures better

A

30 degrees angled head back

32
Q

What radiograph can you do to view the mandible better?

A

Orthopantomogram - gives flattened appearance of jaw, can view mandibular condyles well

33
Q

What will often occur in mandible fractures?

A

As it is a curved structure, often have multiple fractures or fracture + dislocation of TMJ

34
Q

Typical lines of fractures that tend to occur in face

A

Supraorbital
Above zygomatic arch and over top of nose
Below zygomatic arch and maxilla
Mandible

35
Q

What is a tripod fracture?

A

Three distinct fractures of zygoma bone affecting its anchoring

36
Q

How does filled sinus appear on CT?

A

Grey if filled with fluid - should be black and filled with air

37
Q

What can we see on cervical spine radiograph?

A

Fractures/subluxation
Atlanto-axial subluxation
Facet dislocation - unilateral or bilateral
Vertebral erosion - eg in RA
Soft tissue widening - abscess/haematoma?
Lung lesion/pneumothorax?

38
Q

Parts of the axis - C2

A

Dens of axis - this is the vertebral body for C1
Superior articular facet (for inferior of C2)
Vertebral body
Inferior articular facet (for superior C3)
Spinous process - lamina arch connecting this to articular facets

39
Q

Normal cervical vertebrae structure

A

Spinous process (bifid)
Lamina arch connecting this to articular facets
Pedicles - connecting body to arch of lamina
Vertebral body
Transverse process
Transverse foramen - for vertebral artery
Groove for spinal nerve (near pedicle)

40
Q

How many cervical spine should you be able to see a cervical spine x ray?

A

Up to C7 - all of them
C7 has longest spinous process

41
Q

Lines to check for in cervical spine x ray

A

Spinous process in line?
Spinal canal line?
Ligaments at the front in line?
Pre-vertebral soft tissue?

42
Q

How far apart should the odontoid peg of the axis be from the atlas?

A

Only 3mm - anymore than this sugegsts pathology/fracture

43
Q

How should the spinous processes appear on frontal cervical xpine x ray

A

Aligned
Equal distant apart

44
Q

How to get good view of odontoid peg of C2 and C1

A

Open mouth x-ray

45
Q

Joint between the atlas and axis called?

A

Atlantoaxial

46
Q

What else does the atlas articulate with?

A

Occiptal bone - atlantooccipital joint

47
Q

How should an open mouth x-ray appear?

A

Lateral masses ox atlas should be aligned with axis
Dens should be equal distance from each lateral mass of axis

48
Q

C1 atlas normal structure

A

Anterior and posterior arch
Lateral massess
Inferior articular surfaces

49
Q

What is a jefferson fracture?

A

Fracture of C1 in 2 places
Usually happens on axial loading eg when diving into pool head first

50
Q

What is the three column concept in spinal fractures?

A

Splits spinal column into 3
Anterior is front of vertebral body
Middle is posterior vertebral body
Posterior is everything behind that (spinous process etc)

If fractures occur through 2 of these = spinal column is unstable

51
Q

What is the problem that radiographs can miss when looking at cervical spine?

A

Ligamentous injuries - consider CT if significant mechanism of injury or MRI if suspect spinal cord pathology

52
Q

Ligaments lining spinal cord

A

Supraspinous
Interspinous
Ligamentum flavum
Posterior longitudinal
Anterior longitudinal

53
Q

I have not included the NICE guidelines for CT cervical spine

A

May be check if you need to know them

54
Q

Extradural haemorrhage appearance on CT

A

Lentiform/convex shape - usually caused by middle meningeal artery lesion from skull fracture from blow to side of the head (esp pterion)

55
Q

What occurs in pt’s with extradural haemorrhage?

A

Lucid interval - suddenly seem ok then have FAST deterioration

56
Q

What happens to subdural haemorrhage blood as it gets older and is scanned later?

A

Becomes very similar to brain shade of grey - difficult to pick up if they are scanned later

Acutely the blood is bright white but then greys and eventually blackens (looks just like fluid)

57
Q

Causes of subdural haemorrhage

A

Child - Trauma or physical abuse

Adult - trauma

Elderly - mild trauma

58
Q

Why does it take only mild trauma to cause subdural haemorrhage in elderly?

A

Brain involutes as you age
This means bridging veins are put under more tension as they travel from subarachnoid through subdural and to dural venous sinuses

59
Q

Cause of subdural bleed

A

VENOUS - bridging veins

60
Q

Subdural CT appearance

A

Cresenteric shape

61
Q

Acute vs chronic subdural bleed

A

Acute - history of trauma/symptoms
Chronic - confusion

62
Q

Subdural haemorrhage treatment

A

Correct anticoagulation - warfarin increases risk of haemorrhage
Small can be conservatively managed, further CT if they detriorate
Large is neurosurgical emergency (like extradural)

63
Q

Two causes of subarachnoid haemorrhage

A

If peripheral - likely to be trauma
If central from circle of willis likely to be aneurysm/vessel rupture

64
Q

Describe trauma subarachnoid bleed

A

Small vessels bleed
Peripheral hyperdensity following sulci of brain
Can be asymptomatic

65
Q

Management of subarachnoid trauma haemorrhage

A

Small with normal GCS score can be managed conservatively
- correct anticoagulation and do further CT if deteriorate

66
Q

Describe ruptured aneurysm subarachnoid haemorrhage

A

Arterial bleed due to aneurysm
Central hyperdensity within subarachnoid space

67
Q

Symptoms of subarachnoid haemorrhage due to aneurysm bleed

A

THUNDERCLAP headache - sudden and worse headache of someones life

68
Q

What test to do if CT appears normal but still suspect subarachnoid haemorrhage?

A

Lumbar puncture

69
Q

Management of ruptured aneurysm causing subarachnoid haemorrhage

A

EMERGENCY - angiographic imaging needed and treat aneurysm

Head and Neck (26 decks)

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