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Flashcards in Infrahyoid Neck Deck (36)
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1
Q

What are the spaces of the infra hyoid neck?

A
  1. Visceral
  2. Carotid
  3. Retropharyngeal
  4. Posterior cervical
  5. Perivertebral
2
Q

What is the visceral space?

A

Central compartment containing several viscera: larynx, thyroid, hypo pharynx and cervical oesophagus.
Extends from hyoid to mediastinum; no supra hyoid extension.

3
Q

What is the carotid space?

A

Paired space just lateral to the visceral compartment. Contains CCA, ICA, IJV, vagus.

4
Q

What is the retropharyngeal space?

A

Small virtual space containing only fat; continuous with the supra hyoid space and the middle mediastinum

5
Q

What is the posterior cervical space?

A

Paired space posterolateral to the carotid space

6
Q

What is the perivertebral space?

A

large space completely encircling vertebral body, including pre and paravertebral muscles.

7
Q

What is the approach to pathology in the infra hyoid neck?

A

1: Which space is lesion?
2: what is normally in this space?
3. What pathology arises from normal contents? Does it fit clinical picture?

8
Q

What are the strap muscles?

A

TOSS:

  • thyrohyoid
  • omohyoid
  • sternohyoid
  • sternothyroid
9
Q

What is the role of the strap muscles?

A

All connected to hyoid and depress hyoid bone and larynx during swallowing and speaking

10
Q

Ddx of lesion in supraglottic larynx?

A
  • Mucosal: squamous Ca
  • Submucosal:
  • -laryngocele
  • -chondrosarcoma
  • -paraganglioma
  • -schwannoma
11
Q

Pathology of hypopharynx / oesophagus?

A
  • Zenker’s diverticulum

- squamous cell Ca

12
Q

Pathology of trachea?

A
  • carcinoma

- benign stenosis

13
Q

Pathology of thyroid?

A
  • Goitre
  • colloid cyst
  • carcinoma (papillary, follicular, anaplastic)
  • Hashimoto’s
14
Q

Pathology of parathyroid?

A
  • Adenoma

- Hyperplasia

15
Q

Embryological remnants which may be found in visceral space?

A
  • Thyroglossal duct

- 3rd branchial cyst

16
Q

How to distinguish paratracheal LNs from thyroid (e.g. tmng) on imaging?

A

LNs lie outside strap musculature

17
Q

Where does the thyroglossal duct run?

A

From the base of tongue at foramen caecum to the thyroid gland

18
Q

What is a thyroglossal duct cyst?

A

Persistence of thyroglossal duct enables development of cyst

19
Q

DDx thyroglossal duct cyst?

A
  • necrotic anterior cervical nodes

- thrombosed jugular vein

20
Q

What is important to check on identification of thyroglossal duct cyst?

A

Thyroid is in normal position:

  • thyroid anlage may never travel along duct
  • remains at tongue base
  • =lingual thyroid
21
Q

Where does the carotid space extend?

A

Skull base to aortic arch

22
Q

Contents (real and potential) of carotid space?

A
  • carotid artery
  • IVJ
  • CNX
  • Sympathetic plexus
  • LNs (level 2-4)
  • Congenital remnants of 2nd branchial cleft
23
Q

Pathology of CCAs?

A
  • Dissection
  • Thrombosis
  • Aneurysm
24
Q

Pathology of IJV?

A
  • Thrombosis

- Thrombophlebitis

25
Q

Pathology of CNX?

A
  • Schwanomma

- Neurofibroma

26
Q

Pathology of sympathetic plexus?

A

-paraganglioma

27
Q

Pathology of LNs of carotid space?

A
  • Lymphoma

- Squamous/thyroid Ca mets

28
Q

Congenital remnant pathology of carotid space?

A

Second branchial cleft cyst

29
Q

Key features of a paraganglioma?

A
  • aka carotid body tumor.
  • Multiple in 4% of patients.
  • 25% have a positive family history.
  • Intense enhancement on CT and MR.
  • Flow voids are frequently present.
30
Q

How may the retropharyngeal space become infected?

A
  1. Classic: paeds ==> URTI spreads to retropharyngeal LNs

2. Penetrating trauma: FBs (fish bones) or iatrogenic (intubation)

31
Q

Contents of posterior cervical space and pathology potential?

A
  • fat (lipoma)
  • CNXI (schwannoma, neurofibroma, MPNST)
  • Brach Plex (as above + apical lung / breast Ca, lymphoma)
  • LNs: lymphoma mets, TB
32
Q

MPNST?

A

malignant peripheral nerve sheath tumour

33
Q

Development pathology of posterior cervical space?

A
  • primitive embryonic lymph sacs (cystic hygroma, lymphangioma)
  • 3rd branchial cleft (cyst)
34
Q

Homogenous enhancement of LNs suggestive of?

A

Lymphoma

35
Q

What is lymphangioma?

A
  • Benign non-capsulated lesion arising from expanding embryonic lymph ‘lakes’ that do not develop normal lymphatic drainage.
  • 90% in children 10% in young adults.
  • occur anywhere in the head and neck; mostly in posterior cervical space. -10% extend into the mediastinum.
  • High signal on T2-weighted images
  • Signal on T1-weighted images depends on protein content.
  • Hemorrhage results in rapid growth and fluid-fluid levels as seen on MR
36
Q

Contents and perivertebral space and potential path?

A
    1. Vertebra (osteomyelitis, 1/met bone Ca)
    1. Muscles (myositis, abscess, sarcoma, fibromatosis)
    1. BPlex: schwanomma, neurofibroma, MPNST
    1. Vert art/vein: aneurysm, dissection, thrombosis