Head and Neck Imaging Studies Lecture Powerpoint Flashcards
Ionic vs non Ionic Iodinated* contrast
Non Ionic is used almost all the time today, used in CT, xray, and angiography (NOT MRI as it isn’t magnetic!!!) via IV administration
Cautions against iodinated contrast (3)
- Iodine allergy
- Shellfish allergy
- Renal insufficiency (relative contraindication depending on severity)
Gadolinium
Used in MRI and MRA but highly contraindicated in renal failure because it cannot dialysize out and thus ends up depositing into soft tissue resulting in possible nephrogenic systemic fibrosis (stiffening of all tissue similar to scleroderma but caused by gadolinium)
Barium swallow vs modified barium swallow (fluoroscopic contrast studies)
Live x ray fluorscopy with water soluble substance (typically barium), either directly or modified (in a cracker, assessing the oropharygeal phase of swallow)
CT is better for ___ visualization, MRI is better for ___ or ___, MRA is best for ___
Bone, soft tissue, nerve, vascular
MRI advantages (2) and disadvantages (3)
\+no radiation \+good soft tissue visualization -more expensive -long time to stay still (may require sedation, CT's are super quick) -pregnancy contraindicated
Generalized pruritis all over can be a sign requiring further evaluation as it may be due to…
….lymphoma
Soft tissues typically DO require ____ when using MRI, while hard bony structures do not.
Contrast
Sinus X rays are ___ recommended to ever be performed, instead a ___ imaging study is preferred
NOT, CT
FEES
Fiberoptic endoscopic evaluation of swallowing, passing a scope thru the nose and down into the back of the throat then having a patient eat and drink, a non radiation alternative to X ray to visualize food bits left in piriform sinus (posteriolateral on either side of laryngeal opening)
Sialogram of parotid
Dilation and cannulation of parotid with plastic tube followed by injection of dye to assess for sialolith or other blockage, not often used opposed to sialendoscopy (can visualize and treat in one go) or the CT
Plain vs doppler ultrasound
Doppler ultrasound sees the flow of blood unlike a plain
Normal vs non normal lymph nodes on ultrasound
Oval and fat filled deposits (appear as discoloration within the lumen on ultrasound) are normal while non normal tend to be round and dark
PET scan
Positon emission tomography, use of X ray or CT following injection of radionucleotide product most often using fluorodeoxyglucose (FDG) (radiotagged sugar that measures high metabolic activity)
Radioactive Iodine uptake scan
Discontinued practice compared to ultrasound when formerly used to assess thyroid but often still used in whole body radioactive iodine uptake scan in order to see post thyroidectomy/thyroid cancer to assess treatment
Iodine doesn’t just isolate to the thyroid but also the…
…salivary glands (if using radioactive iodine uptake scan must keep fluids to push it and avoid xerostomia as an unpleasant side effect)
Hereditary hemorrhagic telangectasias (HHT)/osler-weber-rendu disease
AV vascular malformations that can occur anywhere in mucosal surfaces of the body and result in large bleed putting at risk often requiring intervention
Videostroboscopy
Visual assessment of various vocal cord conditions and abnormalities thru mouth or nose, gold-standard in laryngological diagnostic care
Parts of the jaw (parasymphyseal/mental, body, angle, ramus, condyle, and coronoid process)
- Parasymphyseal/mental is near the chin
- the body is the horizontal portion protruding back
- angle is the shift to the vertical
- ramus is the vertical portion before the condyle (posterior) and coronoid processes (anterior)
Mandible condylar fracture common causes, diagnostic study, and treatment
- Often seen with falling and hitting chin on ground or being uppercut
- evident on CT
- not typically treated with intervention but only soft diet (retain bite strength)
Mandible ramus fracture
Sees condyle displacement within the joint and often occurs with counter fracture on opposite side, have a weak bite, treated with surgical intervention
Mandible angle fracture
Occurs near the wisdom teeth and thus may require extraction due to root death potentially
Lefort I-III
-Scale to measure midface fractures described as either complete or one sided (hemi lefort)
I is a palate fracture and can move palate with thumb manipulation
II also includes the nose
III includes the zygomata (craniofacial dysjunction, the face completely removed from the cranium)
Midface fractures often result from…
…often resultant from car accidents or falls
Presbyesophagus
Esophagus where a patient often feels like food gets stuck due to less coordination of their muscles (often in elderly) swallowing resulting in a very clear straight esophagus on a swallow study when it should have constrictions around areas of peristalsis
Zenker diverticulum
An outpouching just below or around the cricopharyngeus where the internal lining of esophagus pouches outward, often diagnosed when swallowed items sit for a period of time and then are coughed back up days later, surgically repairable
Steeple sign
A sign on x ray of narrowing of trachea indicative of croup (laryngotracheobronchitis)
Thumb print sign
A sign of epiglotitis seen on a lateral x ray of the head
Hot potato voice
A characteristic sign of epiglotitis or peritonsillar abscess seen in someone with a thick and muffled voice
Outbowing of ethmoid sinuses is commonly seen on CT and is a sign of….
….nasal polyps
Invasive fungal sinusitis vs allergic fungal sinusitis (mycetoma)
Invasive is an emergency as it eats into bone requiring surgical intervention most often seen in immunocompromised while allergic fungal sinusitis is relatively harmless and can be removed easily
Orbital extension of ethmoid sinusitis
Abscess formation that pushes into the orbit from the ethmoid sinus
Proptosis often requires ____ imaging study to rule out serious pathology
CT imaging of head
Concha bullosa
An enlarged middle turbinate seen in approx half the population that can be resected if causes issue such as congestion or runny nose
Patients with nasal polyps (mucus retention cysts) present completely…
…asymptomatic
Thyroglossal duct cyst origin and sign
Because the thyroid begins growth at the base of the tongue before moving forward and down, congenital malformation of the thyroid gland resulting in cyst in duct located anterior midline neck can result in elevation visually upon sticking tongue out
Why is it important to remove part of the hyoid bone when treating a thyroglossal duct cyst via surgical removal?
Part of the duct travels thru the hyoid bone in order to prevent remnants of the cyst from remaining (sistrunk procedure)
cricopharyngeus
An upper esophageal sphincter that is is a semi-circular muscle located in the neck about three inches below the thyroid cartilage preventing reflux into the throat of food, contracted and tight at most times