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Head and neck radiology > Head and neck imaging > Flashcards

Head and neck imaging Flashcards

1
Q

modality of chouce when looking for obstructing salivary ductal calculi or for detection of fractures

A

CT

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2
Q

Lesions found on PET scan are characterized by a ____ which refers to the relative radioactivity of a particular lesions when standardized to the injection dose and adjusted for body weight

A

standardized uptake value (SUV)

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3
Q

an SUV of greater than 3 is

A

pathologic

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4
Q

nonmalignant conditions that may give rise to an elevated SUV

A

infection and postoperative changes

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5
Q

most common pathology involving the paranasal sinuses and nasal cavity

A

inflammatory disease

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6
Q

characterized by the presence of air-fluid levels or foamy-appearing sinus secretions and is typically caused by a viral upper respiratory tract infection

A

acute sinusitis

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7
Q

in this type of sinusitis, changes include mucoperiosteal thickening, as well as osseous thickening of the sinus walls

A

chronic sinusitis

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8
Q

sphenoid sinusitis is of great clinical concern as it may easily extend in a retrograde fashion intracranially due to

A

presence of valveless veins

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9
Q

characterized by enlargement of cavernous sinuses, with bowing/convex outer mrgins

A

cavernous sinus thrombosis

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10
Q

differential diagnostic conditions for the enlargement of the cavernous sinus would include

A

carotid-cavernous fistula and tolosa-hunt syndrome

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11
Q

used for the evaluation and tx of inflammatory sinonasal disease

A

endoscopic sinonasal sx

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12
Q

major area of mucociliary drainage

A

middle meatus, known as the ostiomeatal unit

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13
Q

obstruction to this region will result in isolated obstruction of maxillary sinus

A

disease limited to the infundibulum

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14
Q

lesion located in this area will lead to combined obstruction of the ipsilateral maxillary sinus, anterior and middle ethmoid air cells and frontal sinus

A

hiatus semilunaris

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15
Q

common complications associated with sinusitis

A

inflammatory polyps, mucuous retention cysts, mucoceles and cavernous sinus thrombosis

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16
Q

chronic inflammation leads to mucosal hyperplasia which results in mucosal redundancy and _____

A

polyp formation

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17
Q

when an antral polyp expands to the point where it prolapses through the sinus ostium, it is referred to as ____. their characteristic appearance is that of a soft tissue mass extending from the maxillary sinus to fill the ipsilateral nasal cavity and nasopharynx

A

antrochoanal polyp

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18
Q

represent obstructed mucous glands within the mucosal lining. these lesions have a characteristic rounded appearance, measuring one to several centimeters in diameter, with the maxillary sinus being most commonly involved

A

mucous retention cysts

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19
Q

results from chronic obstruction of a paranasal sinus that becomes blocked and converted into a fluid-filled cyst. over time, the lesion may expand, eroding bone and resulting in proptosis

A

sinus mucocele

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20
Q

most commonly affected paranasal sinus in mucocele

A

frontal sinus

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21
Q

if the mucocele becomes infected, it demonstrates peripheral enhancement and is referred to as a

A

mucopyelocele

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22
Q

named based in their histologic appearance. in this condition, the neoplastic nasal epithelium inverts and grows into the underlying mucosa. they are not believed to be associated with allergy or chronic infection because they are almost invariably unilateral in location

A

inverted papilloma

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23
Q

inverted papillomas occur exclusively in the

A

lateral nasal wall, centered on the hiatus semilunaris

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24
Q

tx for inverted papilloma

A

sx, because of their increased association with squamous cell carcinoma

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25
Q

typically seen in male adolescents presenting with epistaxis. tumor arises from fibrovascular stroma of the nasal wall adjacent to the sphenopalatine foramen. benign tumor that can be very locally aggressive

A

Juvenile nasopharyngeal angiofibroma

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26
Q

hallmark feature of Juvenile nasopharyngeal angiofibroma

A

retromaxillary pterygopalatine fossa location

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27
Q

this tumor characteristically fills the nasopharynx and bows the posterior wall of maxillary sinus forward. it enhances markedly with contrast administration, differentiating from the rarer lymphangioma

A

Juvenile nasopharyngeal angiofibroma

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28
Q

tx for Juvenile nasopharyngeal angiofibroma

A

embolization, to make them less vascular and facilitate surgical resection

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29
Q

tissues within the paranasal sinuses and nasal cavity that give rise to malignancies include

A

squamous epithelium, lymphoid tissue and minor salivary glands

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30
Q

most common malignancy of the aerodigestive tract

A

squamous cell ca

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31
Q

true or false: squamous cell carcinoma of the sinuses is often clinically silent until it is quite advanced. early symptoms are related to obstructive sinusitis

A

true

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32
Q

minor salivary glands are dispersed throughout the upper aerodigestive tract but are most highly concentrated in the

A

palate

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33
Q

most of the parotid gland salivary neoplasms are benign or malignant

A

benign

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34
Q

most of the minor salivary gland neoplasms are benign or malignant

A

malignant

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35
Q

most common salivary gland malignancies include

A

adenoid cystic carcinoma, adenocarcinoma and mucoepidermoid carcinoma

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36
Q

tumor that arises from the neurosensory receptor cells of the olfactory nerve and mucosa. thus, this lesion may originate anywhere from the cribriform plate to the turbinates. it is quite destructive by the time of diagnosis and is found high within the nasal vault

A

esthesioneuroblastoma

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37
Q

in assessing the size and extent of sinonasal cavity pathology, it is often difficult to differentiate the offending lesion from associated obstructed sinus secretions. in such instances, this MR sequence is of value, because in general, sinus secretions will be brighter than the malignancy, which is often isointense with respect to muscle

A

fat sat T2

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38
Q

skull base extends from the ____ anteriorly, to the _____ posteriorly, and is composed of five bones, namely

A

extends from the nose anteriorly to the occipital protuberance postererioly and is composed of ethmoid, sphenoid, occipital, temporal and frontal bones

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39
Q

most malignant lesions of the skull base are ____ in origin

A

metastatic

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40
Q

3 most common primary malignant tumors in the skull base are

A

chordoma, chondrosarcoma and osteogenic sarcoma

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41
Q

bone neoplasm that arises from remnants of the primitive notochord. classically, this lesion will present as a destructive midline mass centered in the clivus.

A

chordoma

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42
Q

chordoma may be found anywhere along the craniospinal axis, which include

A

35% clivus, 50% sacrum, 15% vertebral bodies

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43
Q

this lesion is characterized as a midline destructive bony lesion with predilection for the sphenoocipital synchondrosis

A

chordoma

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44
Q

occasionally seen as a horizontal line in the midclivus, midway between sella and basion (tip of clivus)

A

sphenoocipital synchondrosis

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45
Q

malignant tumors that develop from cartilage. because skull base is preformed in cartilage, this tumor has predilection to involve the skull base

A

chondrosarcoma

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46
Q

preferred site of origin of chondrosarcoma is

A

parasellar in location, at the petroclival junction

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47
Q

this neoplasm is typically a result of prior radiation therapy or malignant transformation of Paget disease

A

Osteogenic sarcoma

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48
Q

characteristic for chordoma

A

central destructive clival lesion

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49
Q

characteristic for chondrosarcoma

A

paraclival destructive bony lesion

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50
Q

other differential diagnosis aside from chordoma and chondrosarcoma for skull base lesions include

A

metastatases, myeloma, plasmacytoma, fibrous dysplasia and Paget disease

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51
Q

lesions of the jugular foramen are most commonly

A

paragangliomas

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52
Q

this arise from glomus cells derived from the embryonic neural crest, functioning as part of the sympathetic nervous system

A

paragangliomas

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53
Q

paraganglioma in the jugular foramen is called ___. these patients commonly present with pulsatile tinnitus and a conductive hearing loss. CT often demonstrates moth-eaten destruction of the bone surrounding the jugular fossa with MR revealing the typical heterogenous “salt and pepper” signal related to numerous flow voids

A

glomus jugulare

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54
Q

other lesions of the jugular fossa aside from glomus jugulare include ____ and _____. these lesions cause a smooth expansion of the jugular foramen with marked enhancement

A

schwannomas and meningiomas

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55
Q

schwannomas in the jugular fossa affects what CNs

A

IX to XI

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56
Q

most diseases involving the temporal bone are

A

inflammatory in nature and include cholesteatomas

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57
Q

believed to be the principal defect responsible for inflammatory disease of the middle ear and mastoid

A

eustachian tube dysfunction with resultant decreased intratympanic pressure

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58
Q

an epidermoid cyst composed of desquamating stratified squamous epithelium these cysts enlarge because of the progressive accumulation of epithelial debris within their lumen

A

cholesteatoma

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59
Q

congenital cholesteatomas originate from the

A

stratified squamous epithelium of the tympanic membrane

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60
Q

diagnosis of cholesteatoma is based on the

A

detection of a soft tissue mass within the middle ear cavity, typically with associated bony erosion

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61
Q

most common site for formation of an acquired cholesteatoma. cholesteatoma arising in this area originate within the Prussak space (superior recess of the tympanic membrane)

A

superior portion of the tympanic membrane (pars flaccida)

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62
Q

space located medial to the pars flaccida between the scutum and neck of maleus

A

Prussak space

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63
Q

subtle erosion of scutum and medial displacement of the ossicles can be seen in

A

cholesteatoma

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64
Q

also known as the giant cholesterol cyst, is a type of granulation tissue that may involve the petrous apex. these lesions represent petrous apex air cells that have become partially obstructed and are filled with cholesterol debris and hemorrhagic fluid. because of their hemorrhagic components, these lesions are characterized by high signal on both T1 and T2

A

cholesterol granuloma

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65
Q

differential diagnosis for cholesterol granuloma with corresponding MR findings

A

retained fluid secretions (dark T1, bright T2, nonenhancing), petrous apicitis (dark T1, bright T2 with ring enhancement), nonaerated petrous apex (bright T2, dark T2 and non enhancement)

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66
Q

suprahyoid malignancy in pedia

A

lymphoma or rhabdomyosarcoma

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67
Q

vast majority of suprahyoid neck mass in pedia are benign or malignant

A

benign

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68
Q

90% of suprahyoid neck mass in adults are benign or malignant

A

malignant

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69
Q

in younger adults (20 to 40), most common suprahyoid malignancy is

A

lymphoma

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70
Q

in adults over 40, most common neck mass will be

A

nodal metastasis

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71
Q

suprahyoid head and neck is traditionally divided into compartments that include

A

nasopharynx, oropharynx and oral cavity

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72
Q

lies above the oropharynx and is divided from the oropharynx by a horizontal line drawn along the hard and soft palates. posteriorly it is bounded by the pharyngfeal constrictor muscles and anteriorly it is bounded by the nasal cavity at the nasal choana

A

nasopharynx

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73
Q

these are paired funnel-shaped opening between the nasal cavity and nasopharynx

A

nasal choana

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74
Q

oral cavity and oropharynx are divided by a ring of structures that include

A

circumvallate papillae, tonsillar pillars and soft palate

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75
Q

deep anatomy of the head and neck is subdivided by layers of the deep cervical fascia into the following spaces, namely

A

superficial mucosal, parapahryngeal, carotid, parotid, masticator, retropharyngeal and prevertebral

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76
Q

contents of the mucosal space

A

squamous mucosa, lymphoid tissue (adenoids, lingual tonsils), minor salivary glands

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77
Q

pathology in the mucosal space

A

nasopharyngeal ca, squamous cell ca, lymphoma, minor salivary gland tumors, juvenile angiofibroma, rhabdomyosarcoma

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78
Q

contents of the parapharyngeal space

A

fat, trigeminal nerve (V3), internal maxillary artery, ascending pharyngeal artery

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79
Q

pathology in the parapharyngeal space

A

minor salivary gland tumor, lipoma, cellulitis/abscess, schwannoma

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80
Q

contents of the parotid space

A

parotid gland, intraparotid lymph nodes, facial nerve (VII), external carotid artery, retromandibular vein

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81
Q

pathology in parotid space

A

salivary gland tumors, metastatic adenopathy, lymphoma and parotid cysts

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82
Q

contents of the carotid space

A

cranial nerves (IX and XII), sympathetic nerves, jugular chain nodes, carotid artery, jugular vein

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83
Q

pathology in the carotid space

A

schwannoma, neurofibroma, paraganglioma, metastatic adenopathy, lymphoma, cellulitis/abscess, meningioma

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84
Q

contents of the masticator space

A

muscles of mastication, ramus and body of mandible, inferior alveolar nerve

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85
Q

patholgy in the masticator space

A

odontogenic abscess, osteomyelitis, direct spread of squamous cell ca, lymphoma, minor salivary tumor, sarcoma of muscle or bone

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86
Q

contents of the retropharyngeal space

A

lymph nodes (lateral and medial retropharyngeal), fat

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87
Q

pathology in retropharyngeal space

A

metastatic adenopathy, lymphoma

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88
Q

contents of the prevertebral space

A

cervical vertebrae, prevertebral muscles, paraspinal muscles, phrenic nerve

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89
Q

pathology in prevertebral space

A

abscess/cellulitis, osseous metastasis, chordoma, osteomyelitis, cellulitis, abscess

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90
Q

these space includes all structures on the airway side of the pharyngobasilar fascia

A

superficial mucosal space

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91
Q

represents the suprior aponeurosisof the superior pharyngeal constrictor muscle, which inserts into the skull base. this tough fascia separates the mucosal spae from the surrounding parapharyngeal space

A

pharyngobasilar fascia

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92
Q

most common benign lesions arising the mucosal space are

A

Tornwaldt cysts and lesions related to the minor salivary gland tissue

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93
Q

these are sharply marginated and are found in the mdiline with high SI on T2. they are believed to be remnants of notochordal tissue aberrantly located in the nasopharynx and have an incidence of approximately 1 to 2 % in normal patients

A

Tornwaldt cyst

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94
Q

lesions arising from the minor salivary glands include

A

retention cysts and benign neoplasms

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95
Q

these cysts represents obstructed glands similar to those found within the paranasal sinuses

A

retention cysts

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96
Q

most common bening neoplasm in the mucosal space is the

A

beningn mixed cell tumor (pleomorphic adenoma)

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97
Q

triad of radiographic findings in malignant lesion of mucosal space

A

superficial nasopharyngeal mucosal asymmetry, ipsilateral retropharyngeal adenopathy and mastoid opacification

98
Q

important early warning sign in malignancy of mucosal space

A

mastoid opacification; suggests potential dysfunction of the eustachian tube, frequently the result of tumor infiltration of the tensor veli palatini muscles

99
Q

this MR sequence is an invaluable tool allowing detection of infiltrating pathology as the normally bright fat is replaced. it also allows subtle detection of perineural spread of neoplasms, particularly along cranial nerves extending into the skull base

A

precontrast T1

100
Q

this is the most common minor salivary gland malignancy which has a marked perineural spread

A

adenoid cystic carcinoma

101
Q

true or false: altho smoking and alcohol abuse are often associated with squamous cell ca, they have no causal association with nasopharyngeal ca

A

true

102
Q

this immunoglobulin antibodies to Epstein-Barr virus have been associated with nasopharyngeal ca

A

IgA

103
Q

a triangular, fat-filled compartment that extends from the skull base to the submandibular gland region. it is located at the center of the surrounding spaces and is compressed or infiltrated in a charateristic fashion by masses originating from the various spaces. it serves as important landmark of mass effect in the deep face

A

parapharyngeal space

104
Q

spaces surrounding the parapharyngeal space

A

carotid space posteriorly, parotid space laterally, masticator space anteriorly, superficial mucosal space medially

105
Q

mass in the carotid space will displace the parapharyngeal space

A

anteriorly

106
Q

mass in the parotid space will displace the parapharyngeal space

A

medially

107
Q

mass in the superficial mucosal space will displace the parapharyngeal sapce

A

laterally

108
Q

mass in the masticator space will displace the parapharyngeal space

A

posteriorly

109
Q

carotid space lesions can displace what structures

A

pps anteriorly, may separate or anteriorly displace carotid and jugular vein. they sometimes displace the styloid process anteriorly, which narrows the stylomandibular notch

110
Q

how does deep parotid space lesions affect the stylomandibular notch

A

widens the stylomandibular notch

111
Q

most common variation in the vascular anatomy of neck

A

asymmetry of the IJV; most commonly right being larger of the two

112
Q

these are vascular tumors that arise form neural crest cell derivatives

A

paragangliomas

113
Q

when paraganglioma arise from the carotid body, it is called

A

carotid body tumor

114
Q

paragangliomas that arise from the ganglion of vagus nerve

A

glomus vagale tumors

115
Q

paraganglioma that arise along the jugular ganglion of the vagus nerves

A

glomus jugular tumors

116
Q

paraganglioma that arise around the Arnold and Jacobson nerves in the middle ear

A

glomus tympanicum tumors

117
Q

presents with a painless, slowly progressive neck mass that may be pulsatile with an associated bruit. because these lesions are located within the carotid sheath, there are often associated with slowly progressive cranial neuropathies (cranial nerves IX and XII)

A

paragangliomas

118
Q

are paragangliomas mostly solitary or multiple

A

multiple

119
Q

angiographically, paragangliomas are

A

very vascular, with a strong blush in the capillary phase

120
Q

tx for paraganglioma

A

embolization and surgical resection

121
Q

differentiating paragangliomas and neuromas in MR

A

paragangliomas are characterized by multiple flow void and prominent enhancement, but neuromas usually do not demonstrate flow voids and can be cystic

122
Q

these are encapsulated tumors that arise from nerve sheath covering and do not infiltrate the substance of the nerve

A

schwannomas

123
Q

schwannoma within the carotid space often arise from the ___ and present as benign neck mass

A

vagus nerve

124
Q

in contrast to schwannomas, these are not encapsulated and usually occur as multiple lesions that permeate the substance of the nerve fibers

A

neurofibromas

125
Q

principal malignancy of the carotid space

A

squamous cell nodal metastasis

126
Q

serves as the final common efferent pathway of the lymphatic drainage from the head and neck

A

deep cervical jugular nodal chain

127
Q

the only salivary gland with lymph nodes contained within its capsule. this reflects the embryogenesis of the parotid gland, the late encapsulation of which results in the presence of lymph nodes within the gland parenchyma

A

parotid gland

128
Q

most of the benign parotid tumors are

A

benign mixed-cell tumors (pleomorphic adenomas)

129
Q

second mass common benign salivary gland tumor is

A

Warthin tumor

130
Q

malignant tumors of the parotid gland include

A

adenocystic carcinoma, adenocarcinoma, squamous cell carcinoma and mucoepidermoid carcinoma

131
Q

feature predictive of malignancy in the neck is

A

infiltration into deep neck structures, such as the masticator or parapharyngeal space. clinical involvement of the facial nerve is another ominuous finding suggestive of malignancy

132
Q

parotid cysts aka lymphoepithelial cysts has been seen in these conditions ___. they are believed to be the result of partial obstruction of the terminal ducts by surrounding lymphocytic infiltration

A

collagen vascular disease (Sjogren syndrome) and in patients with AIDS

133
Q

this space is formed by a superficial layer of deep cervical fascia that surround the muscles of mastication and mandibile. it extends from the angle of mandible superiorly to the skull base and over the temporalis muscle

A

masticator space

134
Q

muscles of mastication

A

temporalis, medial and lateral pterygoids, masseter

135
Q

most masses of masticator space are of what origin

A

infectious

136
Q

pseudotumors of the masticator space are common which include

A

accessory parotid glands as well as marked muscle hypertrophy resulting from bruxism

137
Q

asymmetry of the muscles of mastication may result from unilateral atrophy, owing to compromise of what nerve. this is also most commonly seen in patients with head and neck neoplasms with perineural extension along this nerve

A

mandibular division of trigeminal nerve (V3)

138
Q

complication of oropharyngeal or nasopharyngeal lesions

A

may spread along V3, allowing tumor to ascend through the foramen ovale into the cavernous sinus

139
Q

primary malignancies of masticator space

A

sarcoma, chondroid or nerve elements, non-Hodgkin lymphoma

140
Q

presents as a well-circumscribed parotid mass which is bright on T2 and demonstrates heterogeneous contrast enhancement. these imaging features are consistent with a

A

benign pleomorphic adenoma

141
Q

may present as innumerable tiny parotid cysts reflecting the lymphocytic infiltration of the exocrine glands, which causes lympahtic obstruction and cyst formation

A

parotid cysts or benign lymphoepithelial cysts

142
Q

signs of perineural spread in MRI

A

nerve thickening, widening of the neural foramen, loss of fat surrounding the nerve, abnormal perineural contrast enhancement

143
Q

potential space that lies posterior to the superficial mucosal space and pharyngeal constrictor muscles and anterior to the prevertebral space

A

retropharyngeal space

144
Q

a mass within this space results in characteristic posterior displacement of the prevertebral muscles

A

retropharyngeal space

145
Q

this space serves as a potential conduit for the spread of tumor or infection from the pharynx to the mediastinum

A

retropharyngeal space

146
Q

most lesions of the retropharyngeal space are a result of

A

infection or nodal malignancy

147
Q

this space is most often involved with nodal malignancy because of lympho,a or metastatic head and neck squamous cell carcinoma

A

retropharyngeal space

148
Q

these retropharyngeal nodes are normal when seen in younger patients but must be viewed with suspicion in individuals older than 30 y.o

A

lateral retropharyngeal nodes aka nodes of Rouviere

149
Q

this is formed by the prevertebral fascia, which surrounds the prevertebral muscles. masses on this space displace the prevertebral muscles anteriorly. this allows prevertebral lesions to be easily differentiated from retropharyngeal processes.

A

prevertebral space

150
Q

structures that give rise to most pathologies in this space are the cervical vertebral bodies. any process that involves the vertebral bodies, such as tumor (metastasis, chordoma, etc) or osteomyelitis, may extend anteriorly to involve this space

A

prevertebral space

151
Q

transpatial diseases refers to masses that may not be localized to one of the neck spaces, but are often secondary to lesions involving anatomic structuresn that normally traverse spaces of the head and neck, examples of which are

A

lymphatic masses (lymphangiomas), neural masses (neurofibroma, schwannoma, perineural spread of tumor) and vascular masses (hemangioma)

152
Q

these congenital neck abnormalities look quite similar on MR. both of them have increased SI on T2 and are infiltrative. They may have phleboliths and evidence of blood degradation. both entities should be considered in a patient with a history of chronic facial swelling and who shows CT or MR evidence of an infiltrative process that traverses several spaces

A

lymphangiomas and hemangiomas

153
Q

these conditions have a particularly proclivity for perineural spread of disease, which serves as a hallmark of these diseases.

A

fungal infections, squamous cell carcinoma, adenoid cystic carcinoma

154
Q

if a patient with a known head and neck primary neoplasm or immunocompromised status (susceptible to fungal infections) presents with facial numbness or dyesthesias, this is highly suggestive of

A

perineural spread of disease

155
Q

contains the precricoid (Delphian), pretracheal, paratracheal, and perithyroidal nodes, including those along the recurrent laryngeal nerves, and the external branch of the superior laryngeal nerve. parathyroid glands are also normally located here

A

central neck (level VI)

156
Q

superior margin of thyroid and lymph node basins

A

level of hyoid bone

157
Q

inferior margin of thyroid and lymph node basins

A

level of brachiocephalic vessels

158
Q

lateral margins of thyroid and lymph node basins

A

medial aspect of the common carotid arteries

159
Q

serves as the final common afferent pathway for lymphatic drainage of the entire head and neck. this nodal chain folows the oblique course of the jugular vein beneath and adjacent to the anterior border of SCM

A

internal jugular nodal chain

160
Q

highest node of the IJ chain

A

jugulodigastric node

161
Q

this is immediately posterior to the submandibular gland and provides lymphatic drainage from the tonsil, oral cavity, pharynx and submandibular nodes

A

jugulodigastric node

162
Q

most LN of the head and neck should be equal to or less than 1 cm in short axis except the ___ and ____ nodes which may normally measure up to 1.5 cm in diameter

A

jugulodigastric and submandibular nodes

163
Q

several LN features that suggest malignancy are

A

peripheral nodal enhancement with central necrosis, extracapsular spread with infiltration of adjacent tissues and matted conglomerate mass of nodes

164
Q

contains both the extraconal and intraconal spaces

A

retrobulbar space

165
Q

extraconal and intraconal spaces are separated by the muscle cone or

A

“annulus of Zinn”

166
Q

this muscle cone is formed by the extraocular muscles (superior, inferior, medial and lateral rectus; superior oblique and levator palpebrae superior) and a fibrous septum. together these structures form a cone with its base at the posterior of the globe and its apex at the superior orbital fissure

A

Annulus of Zinn

167
Q

composed of the optic nerve and surrounding perioptic nerve sheath

A

optic nerve sheath complex

168
Q

this is an extension of the brain enveloped by CSF and leptomeninges, which form the optic nerve sheath

A

optic nerve

169
Q

CSF space that envelopes the optic nerve is continuous with the intracranial subarchnoid space. therefore, if a lesion arises from the optic nerve sheath complex, the most common lesion is either an ____ or ______

A

optic nerve glioma or optic sheath meningioma

170
Q

most common tumor of the optic nerve and typically occurs during the first decade of life. it has high association with NF1, particularly when there is bilateral optic nerve involvement, these lesions are low-grade pilocytic astrocytomas

A

optic nerve glioma

171
Q

characteristic imaging finding in optic nerve glioma

A

enlarged optic nerve sheath complex that may be tubular, fusiform or eccentric with kinking

172
Q

some optic nerve gliomas have extensive associated thickening of the perioptic meninges. histologically, this reflects peritumoral-reactive meningeal changes, which has been termed ______. this finding is often seen in patients with neurofibromatosis

A

“arachnoidal hyperplasia” or “gliomatosis”

173
Q

arise from hemangioendothelial cells of the arachnoid layer of the optic nerve sheath. these lesions assume a circular configuration and grow in a linear fashion along the optic nerve. they also demonstrate a characteristic “tram track” pattern of linear contrast enhancement, because the nerve sheath enhances, rather than the nerve itself

A

optic sheath meningiomas

174
Q

difference between optic nerve glioma and optic sheath meningioma

A

meningiomas may invade and grow through the dura, resulting in an irregular and asymmetric appearance. In addition, optic sheath meningiomas may be extensively calcified, whereas optic nerve gliomas rarely have any calcification

175
Q

these conditions may mimic “tram track” appearance of optic nerve sheath meningiomas

A

sarcoidosis, leukemia or lymphoma

176
Q

important differential diagnostic consideration for enhancement of the optic nerve sheath is

A

optic neuritis

177
Q

this condition demonstrates abnormal T2 hyperintensity and contrast enhancement as a result of inflammation of the optic nerve itself. it presents with acute visual deficit, often described as “blurring” of vision and can be the first sign of multiple sclerosis. approximately 20% of patients with MS initially presents with an episode of this condition

A

optic neuritis

178
Q

vascular lesions that may develop in the orbit

A

capillary hemangioma, lymphangioma, cavernous hemangioma and varix

179
Q

this vascular lesion develop in infants and are diagnosed within the first weeks of life. altho these lesions may grow rapidly in size, they typically plateau during the first year or two then regress spontaneously. on imaging studies , it appears as infiltrative soft tissue complex, often with multiple vascular flow voids

A

capillary hemangiomas

180
Q

vascular lesion that is one of the most common orbital tumors of childhood and occur in an older group of children (3 to 15 years). they are characterized by their propensity to bleed, and they often contain blood degradation products. an acute hemorrhage may result in marked expansion of the lesion with sudden proptosis

A

lymphangiomas

181
Q

these are one of the most common orbital masses in adults. in contrast to the other vascular lesions of the orbit, these are characterized as a sharply circumscribed, rounded mas. these lesions demonstrate diffuse enchancement, sometimes with a mottled pattern.

A

cavernous hemangioma

182
Q

it is an enormously dilated vein that is characterized by it marked change in size with the Valsalva maneuver

A

venous varix

183
Q

pathologies in the superior ophthalmic vein include

A

thrombosis and enlargement

184
Q

this condition often occurs in conjunction with cavernous sinus thrombosis and presents as loss of normal flow void, with signal intensity related to the age of the thrombus

A

superior ophthalmic vein thrombosis

185
Q

enlargement of the superior ophthalmic vein may also be seen with

A

cavernous carotid fistulas

186
Q

this condition represent direct or indirect communication between the internal carotid artery and venous cavernous sinus. These are either spontaneous or posttraumatic, and patients amy present with pulsating exophthalmos and bruit

A

cavernous carotid fistulas

187
Q

these are two important orbital lesions that may present with similar imaging findings.

A

pseudotumor and lymphoma

188
Q

a poorly characterised condition that results from an inflammatory lymphocytic infiltrate. this is the most common cause of an intraorbital mass lesion in the adult population. it is often rapidly developing and presents with painful proptosis, chemosis and ophthalmoplegia

A

idiopathic inflammatory pseudotumor

189
Q

third most common adult orbital mass lesion, following pseudotumor and cavernous hemangioma

A

lymphoma

190
Q

this MR finding is suggestive of orbital pseudotumor

A

dark signal on T2

191
Q

this drug may be valuable in differentiation orbital lymphoma from pseudotumor. it can eliminate pseudotumor in lasting effect while it may be short-lived response in lymphoma

A

steroids

192
Q

when a diffusely infiltrative mass is encountered in a young child anywhere in the head and neck region, including the orbits, this should be considered

A

rhabdomyosarcoma

193
Q

age, imaging features and morphology of orbital capillary hemangioma

A

<1 y.o, flow voids, infiltrative lesion

194
Q

age, imaging features and morphology of orbital lymphangioma

A

3-15 y.o, blood products, multiloculated, lobular mass

195
Q

age, imaging features and morphology of orbital cavernous hemangioma

A

adults, well-circumscribed mass, rounded mass

196
Q

age, imaging features and morphology of orbital varix

A

any age, dilated vein, may enlarge with valsalva maneuver, vascular structure

197
Q

most freq cause of unilateral or bilateral proptosis in adults. this condition is the result of an inflammatory infiltration of the orbital muscles and orbital connective tissues

A

thyroid ophthalmopathy (Grave’s disease)

198
Q

imaging findings in this condition include enlargement of the EOM with sparing of the tendinous attachments of the globe

A

thyroid ophthalmopathy (Grave’s disease)

199
Q

this condition involves the muscle attachments of the globe, in contrast to thyroid ophthalmopathy (Grave’s disease)

A

orbital pseudotumor

200
Q

muscles involved in decreasing order of muscle involvement in thyroid ophthalmopathy (Grave’s disease)

A

“I’m Slow” – inferior, medial, superior and lateral rectus

201
Q

extraconal space primarily contains

A

fat and lacrimal gland

202
Q

lesions arising from the extraconal space are primarily what in origin

A

lacrimal in origin

203
Q

lesions of the lacrimal gland are very nonspecific, but can be divided into

A

inflammatory and neoplastic types

204
Q

neoplasms of the lacrimal gland include

A

epithelial and lymphoid tumors

205
Q

these are any lesions that arise from the salivary glands, such as benign mixed-cell tumor or adenoid cystic carcinoma

A

epithelial tumors

206
Q

lymphoid tumors of the lacrimal gland include

A

lymphoma and pseudotumor

207
Q

most common primary ocular malignancy in pediatric age group and presents characteristically with leukocoria (white pupillary reflex) and a calcified ocular mass

A

retinoblastoma

208
Q

common ocular pathology in adults includes

A

retinal and choroidal detachment, uveal melanoma and metastasis

209
Q

other globe conditions in pediatric patients aside from the common retinoblastoms

A

persistent hyperplastic primary vitreous tumor, Coat’s disease, retinopathy of prematurity and endophthalmitis secondary to Toxocara canis

210
Q

characteristic finding in orbital dermoid

A

presence of fat

211
Q

in children, neck masses tend to be benign, including both congenital and inflammatory lesions. when malignancy is entertained, the most common lesion in the pediatric age group is

A

lymphoma, followed by rhabdomyosarcoma

212
Q

this accounts for about 90% of congenital neck lesions, and usually are found in children but may be seen in adults. it represents an epithelium-lined tract along which the primordial thyroid gland migrates

A

thyroglossal duct cysts

213
Q

thyroglossal duct originates from the ______, extends anterior to the ________ and _______, and ends at the level of ______

A

foramen cecum (at the tongue base), extends anterior to the thyrohyoid membrane and strap muscles, and ends at the level of thyroid isthmus

214
Q

thyroglossal duct normally involutes by

A

8 to 10 weeks of gestation

215
Q

thyroglossal duct is lined by this epithelium, that is why any portion of the duct that fails to involute may give rise to a cyst or sinus tract

A

secretory epithelium

216
Q

75% of thyroglossal duct cysts are located where

A

midline, and most are located at or below the level of the hyoid bone, in the region of the thyrohyoid membrane

217
Q

most common midline neck mass

A

thyroglossal duct cyst

218
Q

tx of choice for thyroglossal duct cyst

A

surgery

219
Q

imaging findings in thyroglossal duct cyst

A

cystic masses with a uniformly thin peripheral rim of capsular enhancement, with occasional septations

220
Q

represents an abnormal dilatation of the appendix of the laryngeal ventricle

A

laryngocele

221
Q

structure that separates the false and true vocal cords and anteriorly ends in a blind pouch termed the appendic

A

laryngeal ventricle

222
Q

it develops as a consequence of chronically increased intraglotitic pressure, as may be seen in musicians (wind instruments)), glass blowers, or excessive coughers

A

laryngocele

223
Q

laryngoceles are classified as ___ , ____ or mixed, according to their location to the thyrohyoid membrane

A

internal, external or mixed

224
Q

laryngocele that are confined to the larynx

A

internal

225
Q

laryngocele that protruce above the thyroid cartilage and through the thyrohyoid membrane, typically present as a lateral neck mass near the hyoid bone

A

external

226
Q

most commonly, laryngoceles have portions that are both in and outside of the thyrohyoid membrane and are called ___

A

mixed

227
Q

laryngoceles that develop without a known predisposing factor should raise the suspicion of an underlying

A

neoplasm, osbtructing the laryngeal ventricle

228
Q

structures of the face and neck are derived from _____

A

branchial cleft apparatus, which consists of six branchial arches

229
Q

may develop if there is failure of the cervical sinus or pouch remnants to regress

A

branchial cleft cyst, sinus or fistula

230
Q

majority of the branchial anomalies are from the

A

second branchial cleft

231
Q

course of the second branchial cleft begins at the

A

base of the tonsillar fossa and extends between the internal and external carotid arteries, anterior to the middle portion of the sternocleidomastoid muscle and lateral to the internal jugular vein at the level of carotid bifurcation

232
Q

usual clinical presentation is that of a painless neck mass along the anterior border of the sternocleidomastoid muscle, presenting during the first to third decade

A

branchial cleft cyst

233
Q

branchial cleft cyst may enlarge with

A

URTI

234
Q

congenita malformation of the lymphatic channgels, these lesions are benign and nonencapsulated. histologically ther are classified as capillary, cavernous or cystic

A

lymphangiomas

235
Q

composed of capillary-size, thin-walled lymphatic channels

A

capullary hemangiomas

236
Q

composed of moderately dilated lymphatics with a fibrous adventitia

A

cavernous lymphangiomas

237
Q

represent enormously dilated lymphatic channels

A

cystic hygromas

238
Q

lymphatic system develops from

A

primitive embryonic lymph sacs that are in turn derived from the venous system

239
Q

represent sequestrations of the primitive embryonic lymph sacs. if this defect is localized, the result is a

A

isolated cystic hygroma

240
Q

time of greatest lymphatic development is at this age and therefore, most of the lymphangiomas present at this age

A

2 y.o

241
Q

lymphangiomas and cystic hygromas are commonly seen in what region of the neck

A

posterior triangle

242
Q

how to differentiate lymphangiomas and cystic hygromas from from other cystic lesions of the neck

A

lymphangiomas and cystic hygromas are easily compressible, they tend not to displace adjacent soft tissue structures

Head and neck radiology (15 decks)

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