Head and Neck Flashcards
Where is the usual origin for pars flaccida cholesteatomas?
Prussak space
(within epitympanum - space at the top of tympanic membrane just behind scutum)
Gradenigo syndrome refers to what triad?
- Otitis media
- Retro-orbital pain
- Abducens (CNVI) palsy
Results from abscess in aerated petrous apex-petrous apicitis
Tullio phenomenon (vertigo & nystagmus induced by loud noises) is caused by what?
Dehiscence of the superior semicircular canal.
Name causes of opaque maxillary sinus
- Trauma (soft tissue swelling, fracture, post-op, epistaxis, barotrauma)
- Neoplastic (carcinoma, lymphoma)
- Inflammatory (Sinusitis, allergies, mucocele)
- Others (fibrous dysplasia, cysts-dentigerous, Granulomatosis with polyangiitis formally called Wegener’s )
Which muscle represents the border between pharynx and cervical oesophagus?
Cricopharyngeus
(typically C5-6 level)
What is Vernet syndrome?
Symptoms caused by pathology at the jugular foramen and affecting cranial nerves IX, X and XI.
Symptoms include loss of taste to the posterior third of the tongue, vocal cord paralysis, dysphasia, weakness of sternocleidomastoid and trapezius.
What is the differential for Vernet syndrome?
Paraganglioma (most common) (moth eaten pattern of the bone, “salt and pepper” appearance)
Neural sheath tumour (smooth scalloping of the adjacent bone).
Jugular foramen metastases
Meningioma
PNET (usually progressive bulbar weakness and destructive mass)
What is the risk of treating with I-131 if you have diffuse lung metastases?
Pulmonary fibrosis
What is the most common major salivary gland tumour and where is it normally found?
Pleomorphic adenoma
most commonly superficial lobe of the parotid
What are the imaging features of a pleomorphic adenoma?
T2 bright with a rim of low signal
What is the only parotid tumour to take up pertechnate?
Warthin’s
What patient’s typically get Warthins tumours?
Male smokers
Usually cystic and bilateral in 15%
Which salivary gland tumour classically has perineural spread?
Adenoid cystic carcinoma
What is the most common malignant tumour of the salivary glands?
Mucoepidermoid carcinoma
Sjogren’s is associated with which parotid pathology?
Lymphoma
(non-Hodgkins MALT type)
What is the differential for a carotid space tumour?
Paraganglioma
Schwannoma
Neurofibroma
What is the location of a glomus vagale (paraganglioma)?
Above the carotid bifurcation but below the jugular foramen
In which paraganglioma would there be destruction of the middle ear floor?
Glomus Jugulare
In which paraganglioma of the inner ear would the floor of the middle ear remain intact?
Glomus Tympanicum
Which carotid space tumour is In- octreotide avid?
Paraganglioma
Pathology in which deep neck space can cause anterior displacement of the parapharyngeal space?
carotid space
Pathology in which deep neck space can cause medial displacement of the parapharyngeal space?
parotid space
Pathology in which deep neck space can cause postero-medial displacement of the parapharyngeal space?
masticator space
Pathology in which deep neck space can cause lateral displacement of the parapharyngeal space?
superficial mucosal space
In regards to cervical lymph nodes, which muscle separates 1a and 1b compartments?
anterior belly of digastric
In regards to cervical lymph nodes, what separates 1b and 2a compartments?
stylohyoid muscle
posterior submandibular gland
In regards to cervical lymph nodes, what separates 2a and 2b compartments?
Jugular/ spinal accessory nerve
In regards to cervical lymph nodes, what separates level 2 from 3?
Lower hyoid
In regards to cervical lymph nodes, what separates level 3 from 4?
Lower cricoid
What is the most common location for a nasopharyngeal SCC?
Fossa of Rosenmuller
What would be the next step if an expanded ventricle is seen on the left in a patient with vocal cord paralysis?
Look at chest for AP window mass
With what syndrome are bilateral colobomas (focal discontinuity of the globe) associated?
CHARGE
Patient with small eye (microphthalmia) with increased density of the vitreous and NO calcification. Can have retinal detachment. Diagnosis?
Persistent hyperplastic primary vitreous (PHPV)
The IgG4 inflammatory condition, orbital pseudotumour has which imaging features?
Expanded muscle which does NOT spare the myotendinous insertions
T2 dark
painful and unilateral
Enlarged pituitary stalk in a post-partum lady. MRI looks like pituitary adenoma but with a T2 dark rim. Diagnosis?
Lymphocytic hypophysitis
Painful expansion of the cavernous sinus presenting as multiple cranial nerve palsies. Diagnosis?
Tolosa Hunt syndrome
Where is the most common location for an orbital dermoid?
Superior and lateral
frontozygomatic suture
“Racoon eyes” can be seen with which malignancy?
Periorbital tumour infiltration with metastatic neuroblastoma
Enhancing mass in the upper outer orbit closely associated with the lacrimal gland. Diagnosis?
MALT lymphoma of the orbit
(associated with Chlamydia Psittaci)
Enhancing soft tissue mass in the back of an adults eye. Diagnosis?
Melanoma
Ill-defined mass of the orbit with fluid-fluid levels which can be intra-conal or extra-conal. Diagnosis?
Lymphangioma
An aberrant internal carotid artery describes the process by which there is involution of the normal cervical portion of the ICA and a collateral pathway formed from enlargement of which 2 arteries?
Inferior tympanic artery.
Caroticotympanic artery.
What is the most common petrous apex lesion?
Cholesterol granuloma
What are the imaging features of a cholesterol granuloma?
T1 and T2 bright.
T2 dark haemosiderin rim.
What are the MRI features of a cholesteatoma?
T1 dark, T2 bright and restricted diffusion
What is the classic triad in Grandenigo syndrome?
Otomastoiditis.
Face pain (trigeminal neuropathy).
Lateral rectus palsy
What are the imaging features of an endolymphatic sac tumour?
Internal amorphous calcifications.
T2 bright.
Intense enhancement.
Very vascular with flow voids.
Large vestibular aqueduct syndrome is the most common cause of congenital sensorineural hearing loss. What is it associated with?
Cochlear deformity including absence of the bony modiolus.
Which structure is eroded early in pars flaccida type cholesteatoma?
Scutum (followed by ossicles then lateral segment of the semi-circular canal).
Which bacteria typically causes necrotising external otitis?
Pseudomonas (in 98%)
Which segments of the facial nerve DO NOT normally enhance?
Cisternal.
Canalicular.
Labyrinthine.
Male teenager with nosebleeds and nasal obstruction.
Diagnosis?
Juvenile nasal angiofibroma.
What are the imaging features of a juvenile nasal angiofibroma?
Centred on sphenopalatine foramen.
Expansion of pterygopalatine fossa.
Vascular.
Mass in the maxillary sinus causing widening of the maxillary ostium and extension into the nasopharynx.
Diagnosis?
Antrochoanal polyp
Inverting papilloma can have malignant transformation most commonly to what?
Squamous cell carcinoma
Mass arising from the lateral wall of the nasal cavity related to the middle turbinate. On MRI there is a “cerebriform pattern” on T1 and T2.
What is the diagnosis?
Inverted papilloma
Mass at the cribiform plate with a dumbbell appearance, avid homogenous enhancement and a posterior cyst.
Octreotide scan is positive.
What is the diagnosis?
Esthesioneuroblastoma.
What does Reidels thyroiditis look like on MRI?
Dark on all sequences (like a fibroma).
What is the most common subtype of thyroid cancer?
Papillary
Microcalcifications in a thyroid cancer and lymph nodes is suggestive of which subtype?
Papillary
Which sub-type of thyroid cancer is associated with MEN II syndrome?
Medullary.
What are the imaging features of a Warthin tumour?
Commonly located in the parotid tail
US: Well-defined with irregular anechoic areas
CT: mural nodule
MRI: low/intermediate on T1, heterogenous on T2, no enhancement
Uptake on Tc99, thallium and PETCT
What syndrome is characterised by a vitreous haemorrhage in association with subarachnoid haemorrhage?
Terson syndrome
Multi-locular predominantly cystic mass with fluid-fluid levels in the posterior neck of a child which can extend into the mediastinum. What is the diagnosis?
Cystic hygroma
(Lymphangioma)
Where would you typically find a second branchial cleft cyst?
Angle of the mandible, anterior to sternocleidomastoid muscle
Where would you typically find a third branchial cleft cyst?
Posterior cervical space, posterior to the sternocleidomastoid muscle
Where would you typically find a first branchial cleft cyst?
Superficial, within or deep to the parotid gland
(can present with facial nerve palsy)
Where would a first branchial cleft sinus drain?
External auditory canal or skin
Where would a second branchial cleft sinus drain?
Tonsillar fossa
Where would a third branchial cleft sinus drain?
Pyriform sinus
Where does a ranula (mucosal retention cyst) arise?
Sublingual gland/ space
