Head and Neck DDx Flashcards
1
Q
Carotid Space Lesion:
A
Reactive lymph node. Jugular vein thrombosis. Nodal mets secondary to SCC. Carotid body paraganglioma. Carotid space schwannoma. Glomus Vagale paraganglioma. Neurofibroma.
2
Q
Parotid Space Mass:
A
Benign Mixed tumour of parotid. Warthin tumour. Metastatic nodal disease . Mucoepidermoid carcinoma of parotid. Adenoid cystic carcinoma of parotid. Malignant mixed tumour. Lymphoma.
3
Q
Laryngeal Lesion:
A
SCC, supraglottic / glottic / subglottic. Vocal cord paralysis Radiated larynx Laryngocele Laryngo-hypopharyngeal reflux Larynx chondrosarcoma
4
Q
Pharyngeal Mucosal Space lesion within Nasopharynx:
A
Adenoid tissue Adenoid inflammation Thornwaldt cyst Pharyngeal mucosal space retention cyst. Nasopharyngeal carcinoma. NHL
5
Q
Pharyngeal Mucosal space lesion within Oropharynx:
A
Tonsillar tissue Palatine tonsil abscess Tonsillar inflammation Retention cyst Base of Tongue SCC Palatine tonsil SCC NHL Thyroglossal duct cyst.
6
Q
Diffuse Parotid Disease:
A
Acute parotitis (unilateral)
Chronic Parotitis
Sjogren syndrome: benign lymphoepithelial lesoins (bilateral).
Benign lymphoepithelail lesion of HIV (bilateral)
Parotid Sialosis
Parotid Mucoepidermoid carcinoma (unilateral)
Parotid adenoid cystic Carcinoma (unilateral).
NHL (unilateral or bilateral)
7
Q
Jugular Foramen Lesion:
A
Gloms jugulare Paraganglioma Jugular foramen Schwannoma Jugular foramen Meningioma Skull base Met Dehiscent jugular bulb Chondrosarcoma Plasmacytoma
8
Q
Enhancing Orbital Mass:
A
Haemangioma Lymphangioma Meningioma Mets Lymphoma
9
Q
Cavernous sinus mass / enhancement:
A
Meningioma schwannoma Carotid-cavernous fistula Tolossa Hunt syndrome Sarcoidosis Peri neural spread
10
Q
Aggressive sinus disease with bony destruction:
A
Invasive fungal disease Wegner granulomatosis Sinonasal carcinoma Lymphoma Cocaine use
11
Q
Unilateral Parotid Mass:
A
Pleomorphic Adenoma Warthin tumour Parotid carcinoma Lymphadenopathy Branchial cleft cyst
12
Q
Bilateral parotid masses:
A
Lymphoepithelial lesions in HIV Sjogren syndrome (lymphoma risk) Warthins tumour Lymphadenopathy Sarcoidosis
13
Q
Orbital Muscle enlargement:
A
Thyroid orbitopathy (I'M SLO) Orbital pseudotumour Lymphoma Sarcoidosis Infectious myositis
14
Q
Masticator space mass:
A
Odontogenic Infection / abscess OsteoSarcoma / Mets Rhabdomyosarcoma (child) Venolymphatic malformation Nerve sheath tumour
15
Q
Carotid space Mass:
A
Paraganglioma
- Carotid body tumour (splays ICA & ECA)
- Glomus vagale (displaces ICA & ECA anteromedially)
Schwannoma (commonly vagal, anteromedial ICA & ECA displacement, less enhancement without flow voids).
Neurofibroma
Vascular abnormality
Lymphadenopathy
16
Q
Retropharyngeal Mass:
A
Infection / abscess
Nodal Mets
Lymphoma
17
Q
Clival Mass:
A
Mets Chordoma Chondrosarcoma Invasive pituitary macro adenoma Plasmacytoma Ecchordosis Physaliphoris.
18
Q
Globe lesion in child:
A
Retinoblastoma
Persistent hyperplastic primary vitreous - Y shape stalk, small globe
Coats disease
Retinopathy of prematurity
Toxocariasis
Coloboma: funnel shape posterior globe. DDx morning glory, with tuft of enhancing tissue at funnelled optic disc.
19
Q
Optic nerve enlargement with enhancement:
A
Optic nerve glioma
optic neuritis
Optic nerve sheath meningioma
Sarcoid
20
Q
Pachymeningeal enhancement:
A
Intracranial hypotension. Mets Pachymeningitis Subdural haemorrhage Sarcoidosis
21
Q
Middle Ear Mass:
A
Acquired cholesteatoma
Facial nerve schwannoma
Glomus tympanum
Cholesterol granuloma
22
Q
Inner ear congenital Malformation:
A
Large vestibular aqueduct syndrome Cystic cochlear vestibular anomaly Cystic common cavity Cochlear aplasia Labyrinthine ossificans
23
Q
Floor of mouth Mass:
A
SCC
Infection / abscess
Ranula
Dermoid / epidermoid cyst
24
Q
Aggressive nasal mass in adolescent:
A
Juvenile angiofibroma nasopharyngeal Enthesioneuroblastoma haemangioma Rhabdomyosarcoma Inverted papilloma Polyp
25
Cystic Neck Mass:
```
Congenital cyst
Abscess
Cystic lymph node / metastatic lymph node
Lymphatic malformation
Cystic nerve sheath tumour
```
26
Jugular foramen mass:
```
Meningioma
schwannoma
Paraganglioma
Met
Dehiscent jugular Bulb
```
27
Leptomeningeal enhancement:
Leptomeningeal carcinomatosis
Meningitis
Neurosarcoid
28
Pulsatile tinnitus:
Venous:
- Idiopathic intra cranial HTN
- Sigmoid sinus diverticulum
- Jugular bulb diverticulum.
Arterial:
- ICA stenosis
- aberrant ICA
- Lateralised ICA
- Persistent stapedial artery
- ICA aneurysm
- Dural arteriovenous fistula
- Arteriovenous malformation.
Hypervascular tumours:
- GLomus tympanum paraganglioma
- Glomus jugulotympanicum paraganglioma
- Haemangioma
- Meningioma
- LCH.
29
Petrous Apex Lesion:
Fluid within petrous apex = apical petrositis.
Bony erosion, restricted diffusion = congenital cholesteatoma.
No restricted diffusion, T1 hyperintense = cholesterol granuloma.
Dural tail = meningioma.
Well circumscribed lytic lesion in child = LCH
Smoothly enhancing bony remodelling intra lesion cysts = schwannoma.
Aggressive appearance = mets / myeloma.
Aggressive appearance, T2 hyperintense = Chondrosarcoma / Chordoma.
30
Floor of mouth cystic lesions:
Ranula - sublingual space
Dermoid / epidermoid: midline, sack of markbles on MR
Thyroglossal duct cyst: midline, usually infrahyoid
Cystic Metastasis - papillary thyroid or SCC.
31
Multiple Sinonasal Lesions:
Acute rhinosinusitis
Chronic rhinosinusitis
Sinonasal polyposis
Allergic fungal sinusitis:
- opacified and expanded sinuses,
- bony remodelling and erosion,
- central hyperdensity and peripheral hypodensity.
Sinonasal retention cyst:
- mucocele.
- Thinning of sinus walls, homogenous on CT / MR.
Invasive fungal sinusitis:
- Complete opacification with focal bone erosion, extension into adjacent compartments.
Granulomatosis with polyangiitis (wegners)
32
Expansile sinonasal lesion:
```
Mucocele
Polyposis
Allergic fungal sinusitis
Ossifying fibroma
Fibrous dysplasia
Solitary polyp
```
33
Sinus lesion with Bone destruction:
```
SCC
Invasive fungal sinusitis
Esthesioneuroblastoma
NHL
Granulomatosis with Polyangiitis.
```
34
Juvenile nasopharyngeal angiofibroma findings:
Adolescent male, with nasal obstruction and epistaxis.
Avidly enhancing nasopharyngeal mass, extends into pterygopalatine fossa.
Expansion of pterygopalatine fossa
Anterior bowing or displacement or posterior maxillary sinus wall.
Internal maxillary artery feeder +/- ascending pharyngeal
35
Hyper dense sinus disease:
Blood
Dense inspissated secretions
Fungal infection - allergic fungal sinusitis.
36
Facial Nerve segments: "I Must Love Going To Make Over Parties"
I: intracranial (cisternal) - should not enhance
M: Meatal: part inside internal auditory canal. Should not enhance.
L: labyrinthine: IAC to ganlgion superior to cochlear. Can occasionally normally enhance.
G: geniculate ganglion - NORMALLY ENHANCES
T: tympanic: horizontal segment, under lateral semi circular canal - NORMALLY ENHANCES
M: mastoid: descending segment, exits at stylomastoid foramen. NORMALLY ENHANCES
P: parotid. Should not enhance
37
DDx of cochlear demineralisation:
```
Retrofenestral otospongiosus
Osteogensis imperfecta (child)
Fibrous dysplasia (young adult)
Paget Disease (older adult)
```
38
DDx for vascular red retrotympanic mass:
Glomus tympanicum
Aberrant carotid artery
Tympanic membrane haemangioma
39
DDx for orbital intraconal Mass:
Optic pathway glioma
Optic nerve sheath meningioma
```
Pseudo tumour
Cavernous Haemangioma
Low Flow lymphatic malformation
Low flow venous malformation (Varix)
Nerve sheath tumour: Schwannoma / neurofibroma.
Mets (Scirrhous breast)
```
40
DDx for orbital extra conal Mass (non lacrimal gland):
Haematoma
Subperiosteal abscess
Lymphoproliferative disease / lymphoma
Mets
Rhabdomyosarcoma (child)
Pseudo tumour
Haemangioma
Sarcoidosis
Sjogren syndrome
Nerve sheath tumours (schwannoma / neurofibroma)
Venous malformation
Lymphatic malformation
Venous varix.
41
DDx for lacrimal gland lesion:
```
Lymphoma
Benign mixed tumour
Pseudo tumour
adenoid cystic carcinoma
mucoepidermoid carcinoma
Sarcoidosis
Sjogren syndrome
Dermoid / epidermoid.
```
42
Parapharyngeal space displacement:
Masticator space lesions displaces PPS posteromedially.
Parotid space lesion disaplces PPS anteromedially.
Carotid space lesion displaces PPS anteriorly.
43
DDx for odontogenic mandibular lesions:
Periapical cyst:
- apex of non vital tooth
- Round, well corticated border, <2cm
Dentigernous Cyst:
- Crown of un erupted tooth
- displaces tooth
Keratogenic odontogenic Tumour:
- Body / ramus
- Grow along length of bone
- Without significant cortical expansion
- Daughter cysts
- Not related to un erupted crown
- Multiple = Gorlin syndrome
Ameloblastoma:
- Extensive tooth root absorption
- Mandibular expansion
- Solid component, enhancing nodule, multi locular.
Odontoma:
- Radiodense with lucent rim.
44
Thyroid cancer Blitz:
```
Papillary:
"Popular with 'Phatic' spread"
- Most common
- Microcalcifications
- Mets via lymphatics
- Excellent prognosis
- Responds well to I-131
- ORPHAN ANNIE EYE nuclei, and Psammoma bodies, on histology
```
```
Follicular:
"Follows", "Flows haematogenously"
- 2nd most common
- Mets haematogenously - liver, bone, lung.
- Responds to I-131
```
```
Medullary:
"MEN 2"
- Calcitonin production
- Local invasion, node and haematogenous spread
- does NOT respond to I-131
```
```
Anaplastic:
"Aged"
- Elderly, radiation Tx
- Aggressive, rapid growth, lymphatic spread.
- does NOT respond to I-131
```
