Head and Neck Imaging

Question 1

Enhancing orbital mass

Answer 1

Cavernous haemangioma
Lymphatic malformation
Meningioma
Mets - breast mets may result in exophthalmos due to desmoplastic reaction
Lymphoma
Nerve sheath tumour

Question 2

Cavernous Enhancement / Mass

Answer 2

Meningioma - encases and narrows the ICA
Schwannoma
Pituitary macroadenoma - encases but does not narrow the ICA
Tolosa-hunt syndrome - related to orbital pseudo tumour
Carotid cavernous fistula
Perineural spread of tumour/infection

Question 3

Aggressive sinus disease with Bone destruction

Answer 3

Invasive fungal sinusitis
Granulomatous disease
Sinonasal carcinoma
Lymphoma
Cocaine use

Question 4

Unilateral parotid mass

Answer 4

Pleomorphic adenoma - bright on T2
Warthin tumour
Parotid carcinoma - mucoepidermoid, adenoid cystic carcinoma
Lymphadenopathy
Brachial cleft cyst

Question 5

Bilateral parotid mass

Answer 5

Lymphadenopathy
Warthin tumour
Sjögren’s syndrome –> lymphocytic infiltration of glandular tissue ; parotid gland enlargement, keratoconunctivitis sicca, xerostomia
Lymphoepithelial lesions
Sarcoidosis - gallium scan will show panda sign

Question 6

Orbital extra-ocular enlargement

Answer 6

Thyroid associated orbitopathy
Orbital pseudotumour –> involvement of the cavernous sinus is known as Tolosa-Hunt Syndrome
Infectious myositis
Neoplasm
Sarcoidosis
Vascular congestion

Question 7

Pharyngeal Mucosal Mass

Answer 7

SCC - arises from fossa of rosenmuller and may obstruct the Eustachian tube
Infection/Abscess
Lymphoma
Thornwalt Cyst
Minor salivary gland tumour

Question 8

Masticator space mass

Answer 8

Infection/abscess
Sarcoma
Venolymphatic malformation - avidly enhance and contain flow voids on T2
Nerve sheath tumour
Haemangioma

Question 9

Carotid Space Mass

Answer 9

Paraganglioma –> carotid body tumour / glomus vagale ; calc and flow voids -> salt and pepper appearance
Nerve sheath Tumour
Vascular abnormality
Lymphadenopathy

Question 10

Retropharyngeal mass

Answer 10

Infection/ abscess
Nodal mets
Lymphoma
Venolymphatic malformation

Question 11

Clival Mass

Answer 11

Metastasis
Chordoma
Chondrosarcoma
Invasive pituitary macro adenoma
Plasmacytoma
Meningioma

Question 12

Vascular neck Injury

Answer 12

Dissection
Pseudoaneurysm - ovoid in appearance and located at the distal aspect of a stenotic segment - doppler - to and fro appearance - ying yang
Vascular Occlusion
Arteriovenous fistula

Question 13

Globe lesion in a Child

Answer 13

Retinoblastoma - hyper dense globe with calcs - trilateral with pineal gland involvement ; quadrilateral with suprasellar involvement ; hyperdense, high on t1 , low on t2 with avid enhancement
Persistent hyper plastic primary vitreous - microopthlamia and increased density in the vitreous , no calcs
Coats disease - normal globe size, no calcs ; retinal detachment
Retinopathy of prematurity - secondary to prolonged o2 therapy –> bilateral micro-ophthalmia,
Toxocariasis

Question 14

Optic nerve enlargement and enhancement

Answer 14

Optic neuritis
Optic nerve glioma - enlargement, elongation, buckling of the optic nerve resulting in dotted i
Optic nerve sheath meningioma - tram track sign
Leukaemia/ lymphoma
Sarcoidosis

Question 15

Pachymeningeal enhancement

Answer 15

Intracranial hypotension
Mets
Pachymeningitis
Sarcoidosis
Subdural haemorrhage

Question 16

Middle ear Mass

Answer 16

Acquired colesteatoma - occurs in Prussic space, blunting of then scutum, ossicular erosion
Facial nerve Schwannoma - enhancing mass within facial nerve canal
Glomus tympanum
Normal vascular variant - aberrant internal carotid artery
Cholesterol granuloma - hyperintense on t1 and t2 due to haemorrhage, possible peripheral rim enhancement

Question 17

Base of tongue mass in achhild

Answer 17

Thyroglossal duct cyst
Lingual thyroid
Epidermoid /dermoid cyst
Haemangioma
Tonsillar hypertrophy
Venolympatic malformation

Question 18

Facial nerve enhancement

Answer 18

Normal facial nerve enahncmenet
Bell palsy
Nerve sheath tumour
Facial nerve haemangioma
Perineural spread of tumour
Ramsey Hunt

Question 19

Floor of mouth mass

Answer 19

SCC
Infection/abscess –> Ludwig angina –> severe, potentially life threatening (due to airway compression) infection with abscess formation inv sublingual, submittal submandibular
Ranula
Venolymphathic malformation
Epidermoid/dermoid cyst
Haemangioma

Question 20

Aggressive nasal mass in a child/adolescent

Answer 20

Juvenile nasopharyngeal angiofibroma
Enthesioneuroblastoma - intracranial extension, dumbbell tumour
Rhabdomyosarcoma
Haemangioma
Sinonasal lymphoma
Inverted papilloma - characteristic linear striations, heterogeneous enhancement

Question 21

Jugular foramen mass

Answer 21

paraganglioma
Schwannoma
Meningioma
Mets
jugular bulb variants

Question 22

Petrous apex mass

Answer 22

Colesterol granuloma - bright on t1 and t2
Mucous retention cyst/ mucocoele
Congenital cholesteatoma
Apical petrosisits –> gradenigo syndrome
Neoplasm

Question 23

Leptomeningeal enhancement

Answer 23

meningitis
leptomeningeal carcinomatosis - lung, breast
neurosarcoidosis
collateral vascular flow -> climbing ivy sign –> atherosclerosis, primary or secondary moyamoya, vasculitis
Subacute infarction