DDX Head and Neck Flashcards
1
Q
7 DDX Soft tissue mas in Middle ear
A
- Cholesteatoma
- Chronic otitis media
- granulation tissue
- cholesterol granuloma
- Glomus typanicum tumor
- Aberrant ICA
- High or dehiscent jugular bulb
2
Q
8 Ddx Vascular lesion in middle ear
A
- Glomus Tympanicum
- extensive glomus jugulare
- Exposed jugular bulb
- aberrant carotid artery
- carotid artery aneurysm
- exposed carotid artery
- Persistent Stapedial artery
- hemangioma
https://link.springer.com/article/10.1007/s00276-013-1127-z
3
Q
6 Ddx Intracanalicular IAC masses
2 Categories
A
- exclusively intracanalicular lesions
- vestibular schwannoma (CN VIII) common
- facial nerve schwannoma (CN VII) rare
- hemangioma
- lipoma
- Not primarily intracanalicular
- meningioma
- epidermoid
4
Q
6 ddx jugular fossa mass
A
Case courtesy of Dr David Gendy, Radiopaedia.org, rID: 75522
- Glomus jugular tumour (paraganglioma) Most common
- schwannoma
- meningioma
- metastases
- chondrosarcoma
- plasmacytoma
5
Q
Ddx mastoid bone defect
A
- Neoplastic bone destruction
- cholesteatoma
- postop simple/radical mastoidectomy
- Post-traumatic deformity
- Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 9672
6
Q
DDx Petrous apex lesions
A
- Cholesterol granuloma (T1 hyperintense) in picture
- Mucocele (T1 hypo, T1 hyper if protenaceous)
- Epidermoid (DWI restriction)
- Chondrosarcoma
- meningioma
- Chordoma (if central extending to petrous)
- endolymphatic sac tumour (rare, more posterior, L>R, if multiple think VHL)
7
Q
Orbital Tumours
9
A
- Orbital capilliary hemangioma (children)
- Lymphoma
- Mets
- Optic nerve sheath meningioma
- optic nerve glioma
- primary ocular melanoma
- rhabdomyosarcoma
- Hemangiopericytoma
- Neurofibroma
8
Q
Inflammatory/Idiopathic orbital Masses
A
- Pseudotumour (idiopathic orbital inflammatory disease) common
- thyroid ophthalmopathy - common
- cellulitis/abscess
- Granulomatous
- Wegener (granulomatous + polyangitis)
- sarcoid
9
Q
DDx Vascular orbital Masses
A
- orbital venous venous malformation (AKA cavernous hemangioma)
- venolymphatic malformation (AKA lymphangioma)
- Carotid-cavernous fistula
- VEnous varix
- Thrombosis of superior ophthalmic vein
- Ophthalmic artery aneurysm
10
Q
DDx optic nerve sheath enlargement
A
- Tumour
- optic nerve glioma
- meningioma
- meningeal carcinomatosis
- lymphoma/leukaemia
- mets
- Inflammatory
- optic neuritis
- orbital pseudotumour with optic perineuritis
- sarcoid
- Raised ICP
- Idiopathic intracranial hypertension
11
Q
ddx Tramtrack enhancement of optic nerve
A
- optic nerve meningioma 1
- optic neuritis 2
- idiopathic
- orbital pseudotumor with optic perineurititis
- sarcoidosis 3
- leukemia, lymphoma
- perioptic hemorrhage
- mets 4
- normal variant (dural enhancement)
12
Q
DDx Third nerve palsy
A
- Occulomotor nerve
- MR
- SR
- IR
- IO
- Compression
- intracranial aneurysm
- uncal herniation
- tumours
- Granuloma
- tolosa hunt
- sarcoid
- infection
- encephalitis
- meningitis
- HZV
- Vasculitis
- dural cavernous fistula
- demyelination
- trauma
- infiltration
- leptomeningeal carcinomatosis
- Oculomotor nerve palsies, or third nerve palsies, result in weakness of the muscles supplied by the oculomotor nerve, namely the superior rectus, inferior rectus, medial rectus, inferior oblique, and levator palpebrae superioris muscles.
- Terminology
- If pupil is normal sized and reactive to light it is called a pupil-sparing third nerve palsy;
- conversely if the pupil is enlarged and non-reactive, it is called a non-pupil sparing third nerve palsy.
- Clinical presentation
- Classically, patients present with diplopia and physical exam findings ipsilateral to the oculomotor nerve (CN III) lesion:
- “down and out” ocular positioning
- abduction, slight depression, and intorsion (due to paralysis of adduction, elevation, and depression)
- complete ptosis
- due to neuropathy affecting levator palpebrae superioris
- +/- enlarged unreactive pupil
- if present, suggests compression of CN III, because the parasympathetic pupillary fibres are located peripherally in the nerve and are more likely affected by external compression
- Classically, patients present with diplopia and physical exam findings ipsilateral to the oculomotor nerve (CN III) lesion:
13
Q
DDx ocular muscle enlargement
A
- Thyroid ophthalmopathy (most common)
- Orbtial pseudotumor (painful)
- infection from adjacent sinus
- granulomatous
- TB
- Sarcoid
- Cysticercosis
- high flow vascular malf
- dural AVM
- CCF
- haemorrage
- tumour
- lymphoma
- rhabdomyosarcoma
- leukarmia
- met
- Trauma
- Acromegaly
14
Q
Mnemonic for childhood orbital masses
LO VISION
A
- Leukaemia
- Optic nerve glioma
- Vascular malf
- infantile capillary hemangioma
- venolymphatic malformations
- Inflamation
- sarcoma/rhabdomyosarcoma
- Ophthalmopathy/Orbital pseudotumour
- Neuroblastoma
15
Q
DDx cystic lesions of the orbit
A
- Dermoid
- epidermoid pic 2
- teratoma (pic 1)
- aneurysmal bone cyst
- cholesterola granuloma
- colobomatous cyst
https://www.sciencedirect.com/science/article/pii/S1319453418300018
Case courtesy of Dr Ayaz Hidayatov, Radiopaedia.org, rID: 54524
16
Q
DDx T1 Hyperintense lesions of the Orbit
A
- Tumor
- melanotic melanoma
- retinoblastoma
- choroidal metastases
- Orbital infantile hemangioma
- Detachment
- Coats disease
- Persistent Hyperplastic Primary Vitreous (PHPV)
- Trauma
- Other
- hemorrhage
- Phthisis bulbi
- Intravitreal oil treatment for detachment
17
Q
DDx Globe Calcifications
A
- Tumour
- retinoblastoma
- 95% are calcified
- 35% are bilateral
- astrocytic hamartoma
- TS
- NF
- Choroidal osteoma
- retinoblastoma
- Infection/chorioretinitis
- Toxo
- herpes
- CMV
- rubella
- Other
- Phthisis Bulbi
- calcs in endstage disease
- Shrunnken bulb
- Optic nerve drusen
- most common cause of calcs in adults
- bilateral
- Phthisis Bulbi
19
Q
DDx Lacrimal Gland Enlargement
A
- Lymphoid lesions
- benign lymphoid hyperplasia
- lymphoma
- Inflam/autoimmune
- orbital pseudotumour
- Sjogren syndrome
- Mikulicz disease
- sarcoid
- Epithelial neoplasm
- pleomorphic adenoma
- ACC
20
Q
DDx Diffuse bone Abnormality
A
- Fibrous Dysplasia
- Paget disease
- Thalassemia
- Osteopetrosis
- Craniometaphyseal dysplasia
- Diaphyseal dysplasia
27
Q
DDx Presyloid space masses (parapharyngeal)
A
- Primary parapharyngeal space masses are rare
- most commonly affected secondarily by extension of local malignancy or infection
- Parotid gland tumor (deep lobe)
- 80% benign
- 20 % malignant
- pleomorphic adenoma
- ACC
- mucoepidermoid Ca
- NPC
- oropharyngeal SCC
- Lymphoma
- Masticator space tumours
- sarcoma
- rhabdomyosarcoma
- Abscess/cellulitis
- Parotid gland tumor (deep lobe)
