H&N

Question 1

Nasopharyngeal SCC

Answer 1

This is more common in Asians and has a bi-modal distribution:
• group 1 (15-30)
typically Chinese
• group 2 (> 40).

Can be caused by Formalin

Involvement of the parapharyngeal space results in
worse prognosis (compared to nasal cavity or oropharynx
invasion)

“Earliest Sign ” of nasopharyngeal SCC is the effacement of the fat within the FOR. Check FOR if you see a Unilateral
Mastoid Effusion or Pathologic Retropharyngeal Node (Nodal mets are present in 90% of nasopharyngeal tumors, with the
retropharyngeal nodes usually the first involved - necrotic level 2 node).

Also look at loss of normal bright T1 of clivus

Metastatic spread within 3 - 5 years post treatment

Question 2

Radiation Necrosis

Answer 2

High-dose radiation (typically >55 Gy) for head and neck tumours.

Asymptomatic or may be symptomatic with focal neurological deficits, seizures, features of raised intracranial pressure, or cognitive impairment

When you think necrosis you should think elevated lipids (found in necrotic tissue) and elevated lactate. You could also reason that NAA, Creatinine, and Choline (makers of cell integrity, metabolism, and turnover) would also be low

Crosses the midline

T1+C: Nodular or curvilinear with soap bubble appearance. May be ring enhancing

MR perfusion: areas of enhancement and high T2/FLAIR don’t show increased rCBV in radiation necrosis or pseudoprogression and could be helpful in distinguishing them from residual lesion or recurrence

Hypometabolic on FDG-PET

Question 3

Hashimoto thyroiditis

Answer 3

• Hashimoto thyroiditis is an autoimmune disease that ultimately produces destruction of the thyroid gland parenchyma. It is the most common cause of hypothyroidism.
• Variety of clinical findings, thyroid function test results, and imaging appearances, dependent on the duration and severity of the disease.
• Ultrasound may show either a diffusely nodular gland or a diffusely coarsened gland without a measurable nodule. The isthmus is characteristically thickened.
• Patients with Hashimoto thyroiditis are at increased risk of thyroid lymphoma. Any rapidly growing nodule should raise suspicion for lymphoma.

Question 4

Graves disease

Answer 4

Graves disease causes autoimmune activation of the TSH receptor, stimulating thyroid hormone synthesis and secretion. Patients clinically present with thyrotoxicosis.
• The typical grayscale sonographic appearance of Graves disease is diffuse enlargement of the gland with a coarsened echotexture. The borders of the gland are often
lobulated.
• The key color Doppler finding is the thyroid inferno sign, which represents marked hypervascularity caused by arteriovenous shunting and enlarged peripheral vessels.

Question 5

Subacute thyroiditis (de Quervain thyroiditis)

Answer 5

Subacute (de Quervain) thyroiditis is granulomatous inflammation of the thyroid, thought to be viral in origin. The gland is usually tender and adjacent cervical adenopathy is common.
• Ultrasound findings are non-specific and may feature a heterogeneous gland with patchy areas of decreased echogenicity.
• Subacute thyroiditis is treated with steroids. Follow-up ultrasound appearance can show a dramatic response to treatment.

Question 6

Multinodular gland

Answer 6

The term multinodular gland is preferred over multinodular goiter because goiter is a
generic term for an enlarged gland, which can have numerous causes.
• On imaging, a multinodular gland will appear enlarged with innumerable mixed cystic
and solid nodules.