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FRCR 2B > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q
A

Cholesterol granuloma

Smooth expansile, well marginated petrous apex lesion

High T1 and T2
Doesnt suppress fat
No diffusion restriciton

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2
Q
A

Cholesteatoma

Petrous apex lesion with smooth expansile bony changes

low T1, high T2
without central parenchymal enhancement restrict diffusions

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3
Q

Smooth lobulated cystic expansion of the petrous apex ?

A

Cephalocele

-Hernation of CNS through defect in cranium.

-In petroux apex, no brain tissue, just CSF/cystic, herniation from meckels cave into the petrous apex

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4
Q

Permeative bone destruction of the posterior petrous ridge. T2 Bright and intense enhancement. lesion extending into the CPA?

A

Endolymphatic sac tumour

**Strongly associated with VHL **

Very vascular often with flow voids.

Retrolabyrinthine: Posteromedial T-bone

Large lesions can involve the CPA cistern, middle ear/mastoid, & jugular foramen

Bone CT: Central intratumoral bone spicules & posterior rim Ca⁺⁺
MR: High-signal foci on unenhanced T1 (haemorrhage and cholesterol). Heterogenous enhancement

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5
Q

Other lesion cause for permeative destruction of petrous apex?

A
  1. Paraganglioma of Glomus Jugulare

Invade the occipital bone/jugular foramen first . Jugular spine eroded

Then spread superolateral to PA and middle ear.

T1
“Salt” refers to hyperintense foci within tumor related to hemorrhage or slow flow.
= Hyperintense foci (quite rare)
+
“Pepper” refers to numerous hypointense foci within tumor, representing high-velocity arterial flow voids
=Hypointense foci common

T1+ C = intense enhancment

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6
Q

Sharply marginated, enlarged JF on bone CT
Fusiform, enhancing mass enlarging JF on T1WI C+ MR?

A

Jugular Foramen Schwannoma

NO Flow voids
Cranial nerve palsy of 9,10,11 (Vernet syndrome)

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7
Q

Permeative-sclerotic involvement of bone around JF on CT
Enhancing JF mass spreading centrifugally along dural surfaces on enhanced MR

A

Jugular Foramen Meningioma

permeative** sclerotic** changes along the JF and lateral clivus

Extend into middle ear, jugular tubercle marrow space and nternal auditory canal

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8
Q

Progressive sensorineural hearing loss. CT shows enlarged vestibular aqueduct?

A

Large vestibular aqueduct syndrome - aka Pendred syndrome

Commonest cause congenital sensorineural hearing loss

Axials - The vestibular aqueduct is never larger than the adjacent posterior semicircular canal

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9
Q

Conductive hearling loss in an adult female?

A

Otosclerosis

Temporal bone CT: Lucent (otospongiotic) foci involving bony labyrinth

Usually in context of normally aerated middle ear

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10
Q

Features of pagets disease of the skull?

A
  1. Well defined and sharp margin of radiolucency affecting the frontal and occipital bones = OSTEOLYSIS CIRCUMSRIPTA
  2. Thickened and expanded sclerotic skull.

OLD person 80s

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11
Q

Pagets skull related complications ?

A

**Deafness
Cranial nerve paresis
Basilar invagination = hydrocephalus = brainstem compression
Secondary High grade osteosarcoma

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12
Q

Young 20-year-old with lytic skull lesion with ground glass appearance?

A

Fibrous dysplasia

Spares the optic capsule - no hearing issues

**McCune-Albirght syndrome = **
Multi-focal fibrous dysplasia, cafe-au-lait spots and precocious puberty

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13
Q

Teenage male with nose bleeds. Mass centred in the sphenopalatine foramen and extends into the pterygopalatine fossa?

A

Juveline nasal angiofibroma

Very vascular.

Blood supply from the ascending pharyngeal artery and or internal maxillary artery.

Not IR. 80% cured by radiation!

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14
Q

Adult 30-40s with nasal obstrictive symptoms. large solitary opacification extending into the nasal cavity from the maxillary sinus with widening of the maxillary antrum?

A

Antrochoanal polyp

effectively a large solitary sinonasal polyp

**No bone destruction, smooth enlargement of the sinus. ** ‘Dumbell shape’

Peripheral enhancement.

Water signal on CT/MRI

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15
Q

Sinus mass arising from the lateral wall of middle meatus, with extension into the antrum?

A

Inverting Papilloma

Cerebriform pattern of enhancement on MRI.

Focal hyperostosis on CT suggests tumour origin/stalk,

Destruction of the medial wall of the maxillary sinus

Trapped sectrions

10% harbour a SCC

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16
Q

Soft tissue mass in the maxillary antrum with destruction of the sinus walls?

A

SCC

Can extend into orbits, brain etc

Decreases T2 signal relative to other sinus pathologies = hypercellular

maxillary antrum is involved in 80% of cases

Note Sinonasal Adenocarcinoma - predilection for ethmoid sinus and enhances more.

Impossible to distinguish from SNUC

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17
Q

20 year old Dumbbell shaped mass with waist at the cribriform plate , with upper portion in the anterior cranial fossa and lower portion in the upper nasal cavity?

A

Esthesioneuroblastoma

Bimodal -m20s or 60s

Avid homogenous enhancement

Somatostatin positive = uptake on octeride scan

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18
Q

Homogeneous soft tissue mass with predilection for nasal cavity, bone destruction and low signal on T2?

A

Sinonasal lymphoma

Also low on T2 and bone destruction like SCC but = Nasal cavity

SCC = Maxillary antrum

Very nonspecific imaging features
can mimic variety of neoplasms & aggressive inflammatory disorders

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19
Q

well circumscribed midline mass in the floor of the oral cavity predominantly of flood density with intralesional fat density cysts?

A

Floor of mouth dermoid

‘sack of marbles’

Epidermoid will ne homogenous fluid signal

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20
Q

Simple well-defined thin walled cyst in the sublingual space?

A

Rannula

Thin-walled SMS cyst with SLS tail = Diving rannula

Crossed mylohyoid

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21
Q

Most common location for ectopic thyroid tissue?

A

Tongue base - ‘Lingual thyroid’

Will be hyperdense like thyroid.

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22
Q

Anterior midline suprahyoid or midline/paramidline infrahyoid cystic neck mass?

A

Thyroglossal cyst

wall enhancement and soft tissue stranding = infected

Nodularity or Ca2+ suggests papillary carcinoma

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23
Q

Which thyroid goitre has significant increased radioactive iodine uptake?

A

Graves disease

50-80%. Visualisation if the pyramidal lobe is accentuated on nuclear medicine.

De Quervain’s/subacute thyroitis uptake is decreased

23
Q

Thin-walled thyroid cysts with multiple echogenic foci and comet-tail artifacts?

A

Colloid cyst

Suspicious features
-Microcalcifications
- increased vascularity
- larger than 1.5cm

24
Thyroid cancer with macrocalcifications?
Papillary Most common (P for Popular) **Mets via lymphatics - Calcification in a node!!! ** Good prognosis and responds well to iodine therapy
25
Second most common thyroid cancer?
Follicular Spread/Mets haematogenously to bone, lung, liver etc Survival is ok. Responds to iodine therapy Hurthle cell type = seen in elderly and doesn't not take up iodine as well as follicular.
26
Uncommon thyroid cancer associated with MEN 2 syndrome?
Medullary Local invasion , lymph and haematogenous spread. CALCIFIED LYMPH NODES DOESNT respond to iodine Elevated Calcitonin
27
Thyroid cancer seen in elderly ?
Anaplastic Uncommon and undifferentiated Rapid growth and lymphatic spread DOESNT respond to iodine
28
Causes of hyperparathyroidism?
Hyperfunctioning adenoma (90%) Multi-gland hyperplasia (8-10) Cancer (1-3) CT parathyroid adenoma shows early arterial enhancement with delayed washout. Can't differentiate from cancer - look for cervical adenopathy
29
Pleomorphic adenoma/Parotid Benign Mixed Tumor Sharply marginated intraparotid ovoid mass uniform enhancement. Very bright T2 signal Small < 2cm - well defined Large > 2cm - Lobulated **90% arise in superficial lobe**. Deep lobe = 'pear shaped' and displaces the PPS medially Most common benign/any major and minor salivary gland tumour. **Can occur in SM and SL glands.** but parotid 90% differentiate from a partoid warthins - Pleomorphic adenoma can have CALCIFICATION
30
Second most common benign tumour in parotid gland?
Warthin Only occur in parotid gland. Usually solid/cystic, male and smoker. Bilateral or multifocal (20%)
31
Two malignant tumours that favour the minor salivary glands?
**Adenoid cystic carcinoma (ACCa)** -Strong propensity for perineural spread -Tends to hematogenous spread to lungs -Slow-growing; may metastasize many years later - Most common malignant tumour of submandibular gland **Mucoepidermoid carcinoma (MECa)** -Tends to spread to lymph nodes -Most common malignant tumour of parotid gland
32
What is the relationship between sjorgens and parotid lymphoma?
Sjorgens has a 100X risk of primary NH MALT type lyphoma of the parotid gland. If bilateral homogenous masses in Sjogren's = lymphoma Can be secondary lymphoma to the parotid gland.
33
Bilateral enlarged parotids with multiple cystic & solid intraparotid lesions ± smooth, round intraglandular calcifications
Sjorgens Honeycombed or leopard skin appearance of the gland Female in 60s/ dry eyes and mouth
34
What are the three classic carotid space tumours?
Paraganglioma Schwannoma Neurofibroma (NF-1)
35
Imaging features of paraganglioma?
'Salt and pepper' from flow voids and heterogenous content Hyper vascular - Intense tumour blush on angio Octreotide positive
36
What are the different types of carotid paraganglioma?
1. Carotid body - at level of bifurication (splaying the ICA and ECA) 2. Glomus vagale - above carotid bifurication but below the jugular foramen 3. Glomus Jugulare - Level of jugular foramen **middle ear floor/PA destroyed 4. Glomus Tympanicum - Confined to middle ear, pulsatile tinnitus. DOESNT destroy destriy the middle ear
37
Imaging features of jugular foramen schwannoma
Sharply marginated, enlarged JF on bone CT Fusiform, enhancing mass enlarging JF on T1WI C+ MR No flow voids Can have cystic changes Not octreotide avid Not all that vascular on angio
38
Imaging features of Glomus jugulare?
Mass in JF with permeative-destructive change of adjacent bone on CT Multiple black dots ("pepper") in tumor indicate high-velocity flow voids from feeding arterial branches on MR
39
Thin-walled, fluid- or air-filled lesion communicating with laryngeal ventricle,
Laryngocele Stenosis at the laryngeal ventricle can be an obstruction from a tumour (15%) +/- extra laryngeal extension through the thyrohyoid membrane
40
Most common benign tumor of the orbit?
Dermoid Arises superior and lateral, arissing from the frontozygomatic suture. Young child
41
What is the most common malignant orbital mass in a child?
Retinoblastoma Chromosome 13 RB suppressor gene - same as osteosarcoma. risk of facial osteosarcoma after radiation therapy 1/3 bilateral. **Calcification in globe of child is classic**
42
What are some of the key differences between a orbital lymphangioma and a venus varix?
Lymphangioma - malformed veins and lymphatics - Money shot = they do not increase with the valsalva -Fluid-fluid levels - mutlilocuted cystic components - transpatial involvement - pre, posr septal, intra and extra conal Varix -Veins only, weak wall and valves - massive dilatation of orbital veins - Distend with provocative measures - imaging can look normal with no Valsalva - Most common cause of spontaneous orbital haemmorhage
43
What is the most common vascular orbital lesion in adults?
orbital Cavernous venous malforation/cavernous haemangioma Weak arterial supply - so slow enhancement with delayed washout - progressive fill in classic lateral intraconal sparing orbital apex Low T1 signal pseudocapsule
44
Common causes of raccoon eyes on physical examination of a child?
Metastatic neuroblastoma Basilar skull #
45
Classic imaging appearances of optic neuritis?
Enhancement of optic nerve increase T2 signal Unilateral and pain
46
What is neuromyelitis optica?
bilateral optic neuritis + myelitis Ocular pain, visual loss, paralysis relapsing and remitting
47
Classic imaging appearance of thyroid orbitopathy?
Enlargement of the belly of extraocular muscles sparing tendon IMSLO - inferior, medial, superior, lateral, oblique Increased volume of infraorbital fat and exophthalmos
48
What are orbital findings associated with NF-1?
Orbital pathway glioma -WHO grade 1 pilocyctic astrocytoma -Expansion nd enlargement of the entire nerve Plexiform neurofibroma (PNF) -Serpentine, unencapsulated, infiltrative masses - enlarge skull base foramina sphenoid wing dysplasia - Cause pulsatile exophthalmos buphthalmos (visible enlargement of the globe) lisch nodules
49
Main causes of Leukocoria (loss of red eye reflex) in a child ?
Retinoblastoma Coats disease Persistent hyperplastic primary vitreous Coats -Normal-sized globe, hyperdense; no Ca⁺⁺ -Subretinal exudate with retinal detachment PHPV -Retrolental tissue & stalk - **small eye** Retinoblastoma -Calcification present in vast majority
50
What are classic features if optic nerve sheath meningioma?
Tram track sign -Enhancing tumor surrounding the non enhancing optic nerve Possible calcification and hyperostosis of adjacent bone Bilateral = NF-2
51
Masses in mandible
Odontoma - - Most common lucent lesion in mandible -Over time shows calcifications that coalesce to form a dense lesion with a lucent rim. - 2nd decade of life **-associated with gardners syndrome ** Ameloblastoma – -Soap appearance, Multilocular , fluid levels -classically arise near the angle of the mandible -locally aggressive so additional features such as tooth resorption and cortical erosion through the bone into adjacent tissues Dentigerous cyst - -Benign, developmental lucent lesion surrounding the crown of unerupted tooth. -Also know as follicular cyst **-crown of a tooth projecting in to the cystic space is pathognomonic** Periapical cyst - any tooth --often the result of a **dental infection **and an associated dental cavity may be seen Odontogenic keratocysts -*destructive, unilocular* lesions centered about the ramus or body of the mandible -Unlike a dentigerous cyst, an odontogenic keratocyst can erode through the cortex of the mandible -multiple odontogenic keratocysts = basal cell nevus syndrome
52
Benign cyst of jaw with aggressive behavior and high recurrence rate
Odontogenic Keratocyst If multiple, with midface hypoplasia, calcification of falx, frontal bossing and prognathism = GORLIN basal cell naevus syndrome
53
Orbital lesions
see picture
54
Deep spaces neck and displacement of PPS
Masitactor space - Posterior-medial Parotid space - Antero-medial Carotid - antero-lateral Pharyngeal muscosa - Posterio-lateral
55
Boundaries of Nasopharynx, oropharynx and hypopharynx?
oropharynx divided from hypopharynx by valleculae.

FRCR 2B (8 decks)

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