BRANT: Chapter 8: Head and Neck Imaging Flashcards
PBR 1 edition
Modality of choice for cases of sialoliths
CT
PET is a functional imaging modality based upon the distribution of a glucose analog radioisotope (18-F-fluorodeoxyglucose). Lesions found on PET scan are characterized by a standard uptake value (SUV). In general, an SUV of greater than ____ is considered pathologic.
3
A major area of mucociliary drainage is the middle meatus, known as the ____
Ostiomeatal unit
Which sinus/es will be obstructed if the infundibulum is diseased?
Maxillary sinus
Which sinus/es will be obstructed if a lesion is found in hiatus semilunaris?
- Maxillary sinus
- Anterior and middle ethmoid air cells
- Frontal sinus
Sinus where most mucus retention cysts are located
Maxillary sinusJ
One of the hallmark features that should elicit the diagnosis of Juvenile Nasopharyngeal Angiofibromas for consideration is its location. Where is it most typically located?
Retromaxillary pterygopalatine fossa
Esthesioneuroblastoma is a tumor that arises from the neurosensory receptor cells of the olfactory nerve and mucosa. Thus, this lesion may originate anywhere from ____ to the turbinates
Cribriform plate
Chordoma is a bone neoplasm that arises from the remnants of the primitive notochord. Its most common location is in the head and neck region is ____
Clivus (35%)
(Sphenooccipital synchondrosis.)
Most common location, in general:
1. Sacrum - 50%
2. Clivus - 35%
2. Vertebral bodies - 15%
This marks the tip of the clivus
Basion
Preferred site of origin of chondrosarcomas
Parasellar region
(petroclival junction)
Most common site for formation of an acquired cholesteatoma
Pars flaccida
(Superior portion of the tympanic membrane)
Cholesteatomas arising in this area originate within the Prussak space (superior recess of the tympanic membrane), which is located medial to the pars flaccida between the scutum and the neck of the malleus. Thus, a finding of soft tissue in this region with subtle erosion of the scutum and medial displacement of the ossicles is characteristic of a cholesteatoma.
This space is located medial to the pars flaccida between the scutum and the neck of the malleus
Prussak space
Lateral aspect of this space is the scutum
The oral cavity and oropharynx are divided by a ring of structures including the following, except:
a. Circumvallate papillae
b. Tonsillar pillars
c. Soft palate
d. Valleculae
d. Valleculae
Contents of the superificial mucosal space
See below
Identify the space highlighted in pink
Superficial mucosal (pharyngeal) space
It represents the superior aponeurosis of the superior pharyngeal constrictor muscle, which inserts into the skull base. This tough fascia separates the mucosal space from the surrounding parapharyngeal space.
Pharyngobasilar fascia
Lesions originating in this space can displace laterally and then obliterate the parapharyngeal space
Superficial mucosal space
Most Tornwaldt cysts are found in this space
Superficial mucosal space
The triad of nasopharyngeal malignancy consists of (1) mucosal mass of the lateral nasopharynx (fossa of Rosenmüller), (2) lateral retropharyngeal nodes and (3) mastoid opacification/effusion. Mastoid opacification is easily detected on T2WIs and suggests potential dysfunction of the ____, frequently the result of tumor infiltration of the ____ muscles.
Eustachian tube
Tensor veli palatini
The levator veli palatini muscle (lvpm), tensor veli palatini muscle (tvpm), medial pterygoid muscle (mptm) and lateral pterygoid muscle (lptm) are represented on the image. Pharyngobasilar pascia (green asterisks).Eustachian tube opening (blue arrow)
It is located at the center of the surrounding spaces and is compressed or infiltrated in a characteristic fashion by masses originating from the various spaces. Thus, it is an important landmark of mass effect in the deep face.
Parapharyngeal space
The parapharyngeal space is a triangular, fat-filled compartment that extends from the skull base to the submandibular gland region
BOUNDED
Anteriorly: Masticator space
Laterally: Parotid space
Medially: Mucosal space
Posteriorly: Carotid space
Mass in this space can displace the styloid process anteriorly, which narrows the stylomandibular notch (the space between the styloid process and the mandible).
Carotid space
Look at the stylomandibular notch
Narrowed: Mass from carotid space
Widened: Mass from parotid space
T/F: Asymmetry of the internal jugular veins is the most common variation in the vascular anatomy of the neck. Marked asymmetry between the size of the left and right jugular veins is common, with the right vein typically being the larger of the two.
True
The following pathologies can be seen in the parapharyngeal space, except:
a. Minor salivary gland tumor
b. Lipoma
c. Cellulitis/abscess
d. Schwannoma
e. AOTA can be seen in the space
e. AOTA can be seen in the space
The following structures can be seen in the parotid space, except:
a. Lymph nodes
b. Facial nerve
c. ECA
d. Retromandibular vein
e. Ascending pharyngeal artery
e. Ascending pharyngeal artery
Ascending pharyngeal artery is seen within the parapharyngeal space
The following are contents of the carotid space, except:
a. CN IX-XII
b. Sympathetic nerves
c. Jugular chain nodes
d. Carotid artery
e. AOTA are contents of the carotid space
e. AOTA are contents of the carotid space
Nerves of origin of glomus tympanicum tumors
Arnold and Jacobson nerves
Identify the affected space
Carotid space
A vascular mass (M) is identified located between the carotid bifurcation, with splaying of the internal and external carotid arteries ( doubleheaded arrow), characteristic of a carotid body tumor. The vascularity and location supports the diagnosis of a paraganglioma, specifically a carotid body tumor. The lesion vascularity typically provides numerous flow voids on MR, yielding a “salt and pepper” appearance. Angiography is helpful in providing preoperative embolization, facilitating surgical resection.
The only salivary gland with lymph nodes contained within its capsule.
Parotid gland
This reflects the embryogenesis of the parotid gland, the late encapsulation of which results in the presence of lymph nodes within the gland parenchyma
Masses in this space push the styloid process and carotid vessels posteriorly. This results in characteristic widening of the stylomastoid foramen. Identify the space.
Parotid space
It is formed by a superficial layer of the deep cervical fascia that surrounds the muscles of mastication and the mandible.
Masticator space
It extends from the angle of the mandible superiorly to the skull base and over the temporalis muscle
The muscles of mastication include the temporalis, the medial and lateral pterygoid, and the masseter
In addition, branches of the trigeminal nerve and the internal maxillary artery are located within this space.
The following can be seen within the masticator space, except:
a. Temporalis muscle
b. Ramus and body of the mandible
c. Inferior alveolar nerve
d. Internal maxillary artery
e. Levator veli palatini
e. Levator veli palatini
In addition, branches of the trigeminal nerve and the internal maxillary artery are located within this space.
Identify the affected space
Masticator space
It is a potential space that lies posterior to the superficial mucosal space and pharyngeal constrictor muscles and anterior to the prevertebral space.
Retropharyngeal space
A mass within this space results in characteristic posterior displacement of the prevertebral muscles.
Contents of the retropharyngeal space:
1. Lymph nodes - lateral and medial retropharyngeal nodes
2. Fat
This space is significant because it serves as a potential conduit for the spread of tumor or infection from the pharynx to the mediastinum, hence also referred to as the “danger space”
Retropharyngeal space
The lateral retropharyngeal nodes, also known as ____, are normal when seen in younger patients but must be viewed with suspicion in individuals older than 30 years.
Nodes of Rouviere
Identify the pathologic space
Retropharyngeal space
The following are contents of the prevertebral space, except:
a. Cervical vertebrae
b. Prevertebral muscles
c. Paraspinal muscles
d. Phrenic nerve
e. Vagus nerve
e. Vagus nerve
It serves as the final common afferent pathway for lymphatic drainage of the entire head and neck.
Internal jugular nodal chain
This nodal chain follows the oblique course of the jugular vein beneath and adjacent to the anterior border of the sternocleidomastoid muscle.
https://radiologyassistant.nl/head-neck/cervical-node-mapping/cervical-node-map
Highest node of the internal jugular chain.
Jugulodigastric node
It is located where the posterior belly of the digastric muscle crosses this chain, near the level of the hyoid bone.
https://radiologyassistant.nl/head-neck/cervical-node-mapping/cervical-node-map
Most lymph nodes of the head and neck should be equal to or less than ____ in short-axis except the ____ and ____ which may normally measure up to 1.5 cm in diameter.
1 cm
Jugulodigastric and submandibular nodes
Several features that suggest malignancy are (1) peripheral nodal enhancement with central necrosis, (2) extracapsular spread with infiltration of adjacent tissues, and (3) a matted conglomerate mass of nodes. Nodal size itself is a less reliable indicator of malignancy, but it is used because the other more reliable differentiating features are frequently not present.
For most orbital abnormalities, including evaluation of the visual pathways, ____ is the procedure of choice
MR
When evaluating for calcification, such as in retinoblastoma in a child with leukocoria or for bony fracture following trauma, ____ is the modality of choice.
CT
The retrobulbar space contains both the extraconal and the intraconal spaces, which are separated by the ____
Annulus of Zinn
Identify the EOM involvement in order of decreasing frequency in thyroid ophthalmopathy
I’M SLow
Inferior, Medial, Superior, and Lateral rectus muscles
Identify the pointed structure
Superior ophthalmic vein
It represents an epithelium-lined tract along which the primordial thyroid gland migrates. This tubular structure originates from the foramen cecum (at the tongue base), extends anterior to the thyrohyoid membrane and strap muscles, and ends at the level of the thyroid isthmus.
Thyroglossal duct
The duct normally involutes by 8 to 10 weeks of gestation.
Seventy-five percent of thyroglossal duct cysts are midline, and most are located at or below the level of the HYOID BONE in the region of the thyrohyoid membrane. In fact, thyroglossal duct cysts are the most common midline neck mass.
The laryngeal ventricle separates the false and true cords and anteriorly ends in a blind pouch termed the ____.
Appendix
Although branchial abnormalities can arise from any of the pouches, the majority (95%) arise from the ____
SECOND branchial cleft
The course of the second branchial cleft begins at the base of the tonsillar fossa and extends between the internal and external carotid arteries. Thus, second branchial cleft cysts are typically found along this pathway, anterior to the middle portion of the sternocleidomastoid muscle and lateral to the internal jugular vein at the level of the carotid bifurcation.
Name the pointed structure
Ethmoid bulla
The following are part of the osteomeatal complex, except:
a. Middle meatus
b. Ostia of the anterior ethmoid sinuses
c. Sphenoethmoidal recess
d. Frontal recess
c. Sphenoethmoidal recess
The ostiomeatal complex or unit is not a discrete anatomic structure, but rather refers to a functional unit of structures that include the middle meatus, the uncinate process, the infundibulum, the maxillary sinus ostium, the ethmoid bulla, and the ostia of the anterior ethmoid sinuses and the frontal recess.
T/F: The Schneiderian mucosa is thicker over the medial surface of the inferior and middle turbinates than it is over the lateral surfaces of these turbinates. This is the result of an increase of the lamina propria, which extends from the basement mem- brane of the pseudostratified epithelium to the adjacent bone. It is within this lamina propria that the venous sinusoids, lymphocytes, seromucinous glands and immunocompetent cells are located.
True
Please study:
Atlas of Normal Anatomy of the Paranasal Sinuses
Som Page 141
It forms the anterior wall of the pterygopalatine fossa
Perpendicular plate of the palatine bone
Anterior wall: Perpendicular plate of the palatine bone
Posterior wall: Pterygoid plate of the sphenoid bone
Medial wall: Sphenopalatine foramen
Lateral wall:
The pterygopalatine fossa communicates with five anatomic areas: (1) the nasal fossa (via the sphenopalatine foramen); (2) the mouth (via the greater and lesser pterygopalatine canals, which open on the palate through the greater and lesser pala- tine foramina); (3) the infratemporal fossa (via the retromaxil- lary space or fissure); (4) the orbit (via the inferior orbital fissure); and (5) the intracranial compartment and skull base (via the pterygoid or Vidian canal and the foramen rotundum) (Coronal 47 to 50).
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