radiology 2 Flashcards
(317 cards)
1
Q
are interventional measure often done in scotland for salivary obstruction
A
no
2
Q
what are 3 interventional measures for salivary obstruction
A
- surgical removal of the stone
- removal of the gland
- dilate structures of the gland
3
Q
why might surgical dilation of salivary ducts not be possible
A
extent of scar tissue from chronic infection
4
Q
what must the salivary stone be to remove it
A
- mobile
- located in lumen/ main duct
- duct must be patent and wide to allow passage of the stone
5
Q
where must the salivary stone be in the submandibular gland in order to remove it
A
within lumen or main duct distal to the posterior border of the mylohyoid
6
Q
where does a salivary stone by in the parotid duct in order to remove it
A
distal to the hilum or anterior border of the gland
7
Q
what must the duct be for balloon dilation
A
patent anterior to the stricture to allow passage of the equipment
8
Q
what % of balloon dilation results in complete resolution
A
56
9
Q
what 4 tests would be used to test for sjogrens
A
- blood test
- schirmer test
- sialometry
- labial gland biopsy
10
Q
what 5 things are we looking for on an ultrasound for sjogrens
A
- atrophy of the gland
- heterogenous parenchymal pattern
- hypoechoic
- fatty infiltration
- changes suggesting MALT lymphoma
11
Q
what do sjogrens syndrome pts have a higher risk of
A
developing lymphoma
12
Q
what is the number 1 imaging modality for sjogrens
A
ultrasound
13
Q
what is stage 1 on the diagnostic criteria for sjogrens
A
punctate
14
Q
what is stage 2 on the diagnostic criteria for sjogrens
A
globular
15
Q
what is stage 3 on the diagnostic criteria for sjogrens
A
cavitation
16
Q
what is stage 4 on the diagnostic criteria for sjogrens
A
destructive
17
Q
what other changes in the salivary glands mimic sjogrens
A
- radiotherapy
- SLE and sarcoidosis
18
Q
what does radiotherapy do to salivary glands
A
causes atrophy
19
Q
what is scintigraphy
A
injection of radioactive technetium 99 pertechnetate
20
Q
what is the half life of the contrast used in scintography
A
6 hrs
21
Q
what can you used in scintography to gain images
A
gamma camera
22
Q
what does scintography of the salivary glands show us
A
how well the glands are working
23
Q
what will there be in scintography of salivary glands if the gland is working well
A
uptake into the gland
24
Q
what will there be on scintography of salivary glands if there is a tumour
A
reduced uptake
25
which tumour will not be seen on a scintography of salivary glands
warthins tumour
26
what is the first line imaging modality to rule out obstruction or neoplasia of salivary glands
ultrasound
27
when is a biopsy required of salivary gland
if neoplasia
28
what biopsy would be taken for neoplasia of salivary gland
FNA
core biopsy
29
give two examples og benign salivary tumours
- pleomorphic adenoma
- warthins tumour
30
what will a benign tumour of salivary gland be like on imaging
- well defined
- encapsulated
- peripheral vascularity
- no lymphadenopathy
31
name 3 malignant tumours of salivary gland
- mucoepidermoid carcinoma
- acinic cell carcinoma
- adenoid cystic carcinoma
32
what will a malignant salivary gland tumour look like on images
- irregular margins
- poorly defined
- increased/ tortuous internal vascularity
- lymphadenopathy
33
what may low grade malignancy imitate on images
benign
34
what is MRI useful for in salivary glands
surgical assessment of lesions that may not be seen on radiograph
35
which part of which salivary gland may not be seen on radiograph and need MRI
deep lobe of parotid
36
why should you do MRI before biopsy for salivary gland (parotid)
inflammatory appearances may appear on scan complicating diagnosis
37
when would you image minor salivary glands
when pathological or enlarged
38
what image would you take for a minor salivary gland if the indication is superficial
ultrasound
39
what image would you take for a minor salivary gland if the indication is deep
MRI
40
apart from a deep lesion, when else might a MRI be taken for a minor salivary gland
if bony involvement
41
what do minor salivary glands have a higher risk of than major glands
malignancy
42
where might you get bony involvement for minor salivary gland pathology
- retromolar pad
- hard palate
43
what are "B" symptoms of malignancy
- weight loss
- night sweats
44
what type of cancer do night sweats particularly relate to
lymphoma
45
why might malignancy cause issues in moving the tongue
if involvement of the hypoglossal nerve
46
what is the name for changes to a pts voice
dysphonia
47
when might a malignancy pt get loss of hearing
advanced disease - involvement of facial and vestibulocochlear nerves
48
what might malignant bone look like on radiograph
moth eaten
49
name the different things you have to describe about pathology on a radiograph
- site
- size
- shape
- margins
- internal structure
- effects
- tooth involvemnt
- no. of
50
name some radiographic signs of malignancy
- moth eaten bone
- floating teeth
- non-healing sockets
- unusual periodontal bone loss
- spiculated periosteal reaction
- ununsual uniform widening of PDL
- loss of lamina dura
- loss of bony outlines
- thinning of cortical margin
- spiking root resorption
51
what does a rapidly growing radiography lesion suggest
aggressive or malignant
52
which benign lesions grow at a rapid pace
- ameloblastoma
- central giant cell granuloma
- odontogenic maxomas
53
what type of margins would indicate a benign lesion radiographically
corticated defined margins
54
what might lack of cortication indicate
healing lesion
superimposed infection
fast growing lesion
55
what is a bad prognostic sign radiographically of a leison
moth eaten bone with no margins
56
why do benign lesions have corticated margins
because they are slow growing so the bone has time to react and expand with the lesion
57
what will benign lesions do to other anatomical structures
displace them due to slow growth
58
what will malignant lesions do to other anatomical structures
destroy them
59
will a malignant lesion cause displacement of the IAN
no
60
will a benign lesion cause displacement of the IAN
yes
61
what does generalised widening of the PDL indicate
malignancy
62
what does generalised loss of lamina dura indicate
malignancy
63
who is osteosarcoma commonly in
young adults - 30s
64
name 6 risk factors for osteosarcoma
- fibrous dysplasia
- retinoblastoma
- previous exposure to radiation
- previous primary bone cancer
- pagets disease
- chronic osteomyelitis
65
what % of osteosarcoma occur in the head and neck
10
66
what are the 4 most common symptoms of osteosarcoma
- persistent pain
- oedema
- paraesthesia
- B symptoms
67
what will be seen radiographically for late stage osteosarcoma
spiking periosteal reaction
68
what will osteosarcoma look like in its early stages, radiographically
- slightly moth eaten
- widened PDL
69
what is multiple myeloma
proliferation of plasma cells in bone marrow leading to overproduction of immunoglobulins
70
what is a solitary lesion of multiple myeloma called
plasmocytoma
71
what are multiple lesions of multiple myeloma called
multiple myeloma
72
who is most often affected by multiple myeloma
middle aged adults
73
what shape will multiple myeloma be radiographically
round and unilocular
74
what will the internal structure of multiple myeloma be
radiolucent
75
what will the margins of multiple myeloma be radiographically
well defined and not corticated
76
what can large lesions of multiple myeloma lead to
path fracture
77
if multiple myeloma is multi focal what can it affect
all of skeleton
78
which type of lymphoma is most often seen in the head and neck
B cell lymphoma
79
how can lymphoma initially persist
soft tissue lump
80
what is langerhans histocytosis
proliferation of langerhans cells and eosinophilic leucocytes
81
what are the 3 manifestations of langerhans histocytosis
- eosinophilic granulomas
- hand schuller christian disease
- letterer siwe disease
82
what is eosinophilic granulomas
solitary lesion, typically affects adolescents
83
what is hand schuller christian disease
multifocal eosinophilic granulomas
- chronic and widespread, begins in childhood and develops into adulthood
84
what is letterer siwe disease
widespread disease affecting children under 3 years old
85
what shape will langerhans histocytosis be
unilocular
86
what internal structure will langerhans histocytosis have
radiolucent
87
what margins will langerhans histocytosis have
smooth outline
88
what effects does langerhans histocytosis have
floating teeth
89
what 5 tissues cause bone metastasis
- lung
- prostate
- breast
- kidney
- thyroid
90
what will metastasis look like radiographically
- moth eaten
- radiolucent
91
what can breast and prostate metastasis be radiographically
sclerotic/ osteogenic
92
can we decipher between primary and secondary tumours radiographically
no - take good MH and clinical assessment
93
what can low grade malignancy mimic
benign lesion
94
name 3 differential diagnosis' of malignancy on radiographs
- osteomyelitis
- osteoradionecrosis
- MRONJ
95
what is radiopaqueness in pathology due to
- increased thickness of bone
- osteosclerosis of bone
- abnormal tissues
- mineralisation of non-mineralised tissues
96
what is the main deviation between cysts and other pathologies
internal structure
97
what is another name for odontoma
dental hamartoma
98
what is an odontoma
benign tumour of dental tissues
99
what are odontomas made up of
enamel, dentine, cementum and pulp
100
what similarities to normal teeth do odontomas have
- detal follicle
- mature to a certain stage
101
do odontomas grow indefinitely
no, will mature
102
when are odontomas most common
2nd decade
103
what do odontomas correlate with
development of normal dentition
104
which gender is more likely to get odontomas
=
105
what are the two types of odontoma
compound
complex
106
what are compound odontomas
ordered dental structures
107
which type of odontoma are known as 'mini teeth'
compound
108
where are compound odontomas most common
anterior maxilla
109
what are complex odontomas
disorganised mass of dental tissue
110
what appearance will complex odontomas have radiographically
clump of cotton appearance
111
where are complex odontomas more commonly found
posterior mandible
112
what internal structure do odontomas have
mixed radiopacities
113
what are the areas of radiodensities in odontomas
areas of enamel
114
what is the thin radiolucent margin around odontomas
follicle
115
what shape will odontomas have
well-defined
116
what clinical issues may odontomas have
- impaction of adjacent teeth
- root resorption
- dentigerous cyst
117
what is the management of odontomas
excision
118
what is the recurrence of odontomas
nil
119
what is idiopathic osteosclerosis
localised area of increased bone density
120
does idiopathic osteosclerosis have any association with inflammatory, neoplastic and dysplastic processes?
no
121
how are idiopathic osteosclerosis's often diagnosed
incidental
122
what do idiopathic osteosclerosis's have relevance to
ortho Tx
123
what is the incidence of idiopathic osteosclerosis
6%
124
when does idiopathic osteosclerosis present
adolescents
125
when do idiopathic osteosclerosis's stop growing
adulthood
126
where do idiopathic osteosclerosis commonly occur
pre-molar/ molar region of mandible
127
what shape do idiopathic osteosclerosis have raidographically
round, ellipltical, irregular
128
what size are idiopathic osteosclerosis
<2cm
129
what margins do idiopathic osteosclerosis have
well defined
130
what internal structure do idiopathic osteosclerosis have
general homogenous opacity but sometimes slight radiolucent areas
131
what effect do idiopathic osteosclerosis have
nil
132
what is sclerosing osteitis
localised area of increased boen density due to inflammation
133
what causes sclerosing osteitis
chronic low grade inflammation
134
is sclerosing osteitis symptomatic
concurrent symptoms due to source of inflammation
135
does sclerosing osteitis have expansion or displacement of adjacent structures
no
136
what is another name for sclerosing osteitis
condensing osteitis
137
what margins does sclerosing osteitis have
can be well or poorly defined
138
what are sclerosing osteitis's often associated with
apex of necrotic teeth
infected cyst
139
what should you do for sclerosing osteitis if radiographic signs are inconclusive
look for clinical source of inflammation
140
what is hypercementosis
excessive deposition of cementum around root
141
is hypercementosis symptomatic
no
142
is hypercementosis tooth vital
yes
143
what is the cause of hypercementosis
unknown
144
what conditions is hypercementosis common in
pagets disease, acromegaly
145
what is the clinical relevance of hypercementosis
makes XLA more difficult
146
what can be affected by hypercementosis
single or multiple teeth
entirety of root or just a section
147
what radiographic presentation will hypercementosis have
homogenous radiopacity continuous with root surface
148
is the radiodensity of hypercementosis the same as dentine
similar but slightly different
149
what extends around the periphery of hypercementosis
PDL
150
what are the margins of hypercementosis like
often smooth but can be irregular
151
what is cementoblastoma
benign odontogenic tumour of cementum
152
where does cementoblastoma occur
around the root of a tooth
153
is the tooth involved with cementoblastoma vital
yes
154
is cementoblastoma painful
yes
155
what effects can cementoblastoma have
displace adjacent teeth and cortical bone
156
what age does cementoblastoma commonly occur
2nd-3rd decade
157
where does cementoblastoma commonly occur
mandibular molar/premolar region
158
what margin does cementoblastoma have
thin, radiolucent margin continuous with the PDL
159
in cementoblastoma is there a margin that separates the tumour from the root surface
no
160
what radiographic properties does cementoblastoma have
homogenous and round, irregular shape and mixed radiodensity
161
what are tori
bony protuberances of the bone are characteristic sites
162
where do tori occur
- middle of the hard palate
- lingual mandibular premolars
163
what are tori of the palate called
tori palatinus
164
what are mandibular tori called
tori mandibularis
165
do tori grow
yes, slowly
166
what causes tori
unknown - potentially genetics, and masticatory stresses
167
what is the clinical relevance of tori
- hamper denture wear
- potentially traumatised during eating
168
what is the incidence of tori palatinus
20%
169
what age do tori palatinus arise
before 30
170
what is the incidence of tori mandibularis
8%
171
when does tori mandibularis occur
middle age
172
what do tori consist of
- cortical bone
- or mix of cortical and trabecular bone
173
what two phenotypes can tori have
sessile or pedunculated
174
what is an osteoma
benign tumour of bone
175
where does osteoma often occur
can occur anywhere but most often craniofacial skeleton
176
what does osteoma clinically present as
- hard
- asymptomatic
- slow-growing lump
177
how many osteomas will occur at once
can be just one or multiple
178
where do osteomas most commonly occur
posterior mandible
179
what type of bone makes up osteoma
cortical or mix of cortical and trabecular
180
what two phenotypes can osteoma hvae
sessile or pedunculated
181
what type of margins do osteomas have
smooth rounded
182
do osteoma have malignant potential
no
183
what issues might osteomas cause
- aesthetics issues
- functional issues
184
what is the Tx if an osteoma is causing issues
excision
185
what may multiple osteomas indicate
gardners syndrome
186
what is gardners syndrome
variant of familial adenomatous polyposis
187
what is gardners syndrome characterised by
- colorectal polyposis
- osteomas
- soft tissue tumours
188
what dental defects do pts with gardners syndrome have
supernumeraries, impacted teeht and idiopathic osteoclerosis
189
what dental defects do pts with gardners syndrome have
supernumeraries, impacted teeht and idiopathic osteoclerosis
190
why is gardners syndrome significant
colorectal polyps will become cancerous
191
what is the mean age of cancer diagnosis for gardners syndrome if not treated
39
192
what inheritance does gardners syndrome have
autosomal dominant
193
how else can gardners syndrome happen if not genetically predisposed
sporadically
194
what would you do if a pt have multiple osteomas and some impacted teeth
refer for genetic testing and investigation for gardners syndrome
195
what is cleidocranial dysplasia
rare genetic condition with various skeletal defects
196
what bone pattern is seen in in cleidocranial dysplasia
corse trabecular pattern
197
which two bone conditions have overlapping radiographic features
osteomyelitis and osteonecrosis
198
what is osteomyelitis
inflammation of bone and bone marrow due to bacterial infection
199
what is osteoradionecrosis
bone death resulting from irradiation
200
what can help differentiate between osteoradionecrosis adn osetomyelitis
history and clinical history
201
what do osteoradionecrosis adn osetomyelitis result in radiographically
variable mixture of radiolucent and radiopaque areas
202
what is periosteal bone reaction seen in
osteomyelitis
203
what affect on teeth might osteoradionecrosis and osetomyelitis cause
loss of lamina dura
204
if osteoradionecrosis and osetomyelitis is extreme, what might happen
path fracture
205
what is osteolysis
breakdown of bone
206
what does osteolysis cause on the radiograph
radiolucency
207
what is osteosclerosis
thickening of bone
208
what does osteosclerosis cause on the radiograph
radiopacity
209
what is periosteal bone reaction
inflammation results in periosteum laying down new layers of bone around the area
210
what is a giant cell granuloma
reactive lesion with benign tumour like behaviour
211
how fast does giant cell granuloma grow
slowly
212
what effects does giant cell granuloma have
displacement of bone and teeth
213
what affects do a small minority of giant cell granuloma have
fast growing, aggressive form
214
what symptoms do giant cell granuloma have
tender to palpation - nothing else
215
what may you see clinically for giant cell granuloma
invasion into soft tissues
216
what age range do giant cell granulomas occur
before 20
217
what gender is more likely to get giant cell granuloma
female
218
where does giant cell granuloma most commonly affect
mandible anterior to molars
219
what shape will giant cell granuloma be
unilocular
220
what shape will giant cell granuloma if large
multilocular
221
what margins do giant cell granuloma have
well defined, poorly corticated, scalloped
222
what internal structure do giant cell granuloma have
radiolucent or thin septae if present
223
does giant cell granuloma have tooth involvement
no
224
what effects do giant cell granuloma have
displacement of cortices, teeth and occasional root resorption
225
how many giant cell granuloma occur at once
1
226
when is root resorption from giant cell granuloma more likely
when rapidly growing aggressive form
227
what are fibro-osseous lesions
benign condition where bone is replaced with connective tissue or abnormal bone
228
are fibro-osseous genetic
no
229
what are the 3 main types of fibro-osseous
- cemento osseous dysplasia
- fibrous dysplasia
- ossifying fibroma
230
which type of fibro-osseous only affects the jaws
cemento osseous dysplasia
231
can histology differentiate between different types of fibro-osseous
no
232
what plays the biggest part in diagnosing different types of fibro-osseous
radiology
233
why is accurate diagnosis of fibro-osseous lesions important
Tx options vary
234
what does inappropriate management of fibro-osseous lesions do
increase pt morbidity
235
what are the 3 types of cemento osseous dysplasia
- focal cemento osseous dysplasia
- periapical cemento osseous dysplasia
- florid cemento osseous dysplasia
236
what is focal cemento osseous dysplasia
single or a few localised lesions
237
what is periapical cemento osseous dysplasia
lesions associated with apices of mandibular teeth
238
what is florid cemento osseous dysplasia
extensive lesions or many lesions
239
what age groups does cemento osseous dysplasia affect
30-50
240
what gender is more prone to cemento osseous dysplasia
female
241
what ethnicity is more likely to get cemento osseous dysplasia
black ethnicities
242
what site is more likely to have cemento osseous dysplasia
mandible
243
what is often seen clinically for cemento osseous dysplasia
nothing
244
which type of cemento osseous dysplasia is more likely to be expansile
florid
245
are cemento osseous dysplasias painful
rarely
246
are cemento osseous dysplasias assoicated with vital or non-vital teeth
vital
247
is the PDL affected by cemento osseous dysplasia
no
248
what shape will cemento osseous dysplasia be
well defined
249
what does the radiopacity of cemento osseous dysplasia depend on
stage of the lesion
250
how might fully mature cemento osseous dysplasia lesions appear
entirely radiopaque
251
what is ofetn lost with cemento osseous dysplasia
lamina dura
252
does cemento osseous dysplasia cause tooth displacement or resorption
rarely
253
what is the management of cemento osseous dysplasia
usually none
254
when is removal of cemento osseous dysplasia recommended
exposure by:
- XLA
- mandibular atrophy
- trauma etc
255
what is there a risk of following intervention of cemento osseous dysplasia
secondary infection
256
why is biopsy avoided with cemento osseous dysplasia
to avoid secondary infection
257
when would biopsy of cemento osseous dysplasia be done
atypical presentation - rapid expansion
258
why are XLA of involved teeth of cemento osseous dysplasia avoided
to avoid secondary infection
259
what should you consider doing for cemento osseous dysplasia
periodic radiographic review
260
why is cemento osseous dysplasia revied radiographically
to check for formation of solitary bone cysts
261
what are the 3 types of fibrous dysplasia
- monostotic
- polystotic
- craniofacial
262
what is the most common type of fibrous dysplasia
monostotic
263
what is monostotic fibrous dysplasia
single bone affected
264
what is polystotic fibrous dysplasia
multiple lesions affecting multiple bones
265
what is cranciofacial fibrous dysplasia
single lesion affecting multiple bones
266
what is the incidence of fibrous dysplasia
1:30000
267
what is the mean presentation of fibrous dysplasia
25 years
268
what gender is more prone to fibrous dysplasia
=
269
where is fibrous dysplasia most commonly found
posterior maxilla
270
how does fibrous dysplasia present clincally
facial swelling
displaced teeth
painless
271
how will fibrous dysplasia loook radiographically
altered bone pattern
272
what internal structure will have fibrous dysplasia
orange peel, granular, swirling, wispy
273
radiographically, what increases as a fibrous dysplasia lesion matures
radiodensity
274
as the bone in fibrous dysplasia enlarges, what deos it maintain
anatomical shape
275
what margins will fibrous dysplasia have
indistinct, blending into adjacent bone
276
what is the management of fibrous dysplasia if not causing any issues
nil
277
what is the management of fibrous dysplasia if causing issues
- recontouring
- radical resection
278
many fibrous dysplasia lesions stop growing, but what may happen after an event
start growing again
279
give 2 examples of an event that would cause a mature fibrous dysplasia lesion to start growing again
- pregnancy
- jaw surgery
280
what is an ossifying fibroma
fibro-osseous neoplasm in tooth bearing area
281
where do the majority of ossifying fibromas occur
mandible
282
what is the clinical presentation of ossifying fibroma
slow growing bony swelling
painless
283
how does the juvenile subtype of ossifying fibroma differ from the normal type
subtype grows rapidly
284
what age group is affected by ossifying fibroma
any age
285
what is the mean age of presentation for ossifying fibroma
31
286
what gender is more prone to ossifying fibroma
female
287
what shape will ossifying fibroma be
rounded, expansile lesion
288
what affects will ossifying fibroma have
displace teeth, resorb teeth
289
what is the internal structure of ossifying fibroma
ranges from entirely radiolucent to entirely radiopaque
290
what does the radiodensity of ossifying fibroma lesion depend on
maturation of lesion
291
what margins will ossifying fibroma have
well defined
292
what might the surrounding bone of ossifying fibroma be
sclerotic
293
what is the management of ossifying fibroma
removal due to progressive growth
294
how is a ossifying fibroma removed
enucleation or resection
295
what is the rescurrence rate of ossifying fibroma
12%
296
what is pagets disease
chronic condition causing disordered remodelling of the bone
297
how many bones does pagets disease affect
multiple at one time
298
what affects does pagets disease have
- maloccluion
- nerve impingement
- brittle bones
299
what are the symptoms of pagets disease
majority asymptomatic
300
what is the incidence of pagets disease
up to 5% of pts >55
301
what age range is pagets disease rare in
<40
302
what age range is pagets disease more common in
>55
303
what gender is more prone to pagets
male
304
where is pagets disease most commonly found in the world
UK
305
what appearance will pagets disease have on a radiograph
cotton weel - abnormal bone pattern
306
what is the radiodensity of pagets disease linked to
stage of the disease
307
what patches of bone can be seen in pagets disease
osteosclerotic and osteolytic
308
what is seen generally in pagets disease
enlargement of bones
309
what will be seen radiographically in early stages of pagets disease
ostelytic
310
what will be seen radiographically in late stages of pagets disease
osteosclerotic
311
what is the cotton wool appearance of bone in pagets linked to
later stage of disease
312
what is osteoporosis
decreased bone mass
313
how does osteoporosis happen
- age related
- secondary to nutritional deficiencies or medications
314
what affect will be seen around teeth for osteoporosis radiographically
thinned lamina dura
315
what affects on bone will be seen in osteoporosis radiographically
- thinned cortices
- sparse trabecular bone pattern
316
what causes the radiolucent affect in osteoporosis
sparse trabecular bone
317
what is there an increased risk of with osteoporosis
path fractures
