Head and Neck Imaging Studies Lecture Powerpoint

Question 1

Ionic vs non Ionic Iodinated* contrast

Answer 1

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

Question 2

Cautions against iodinated contrast (3)

Answer 2

• Iodine allergy
• Shellfish allergy
• Renal insufficiency (relative contraindication depending on severity)

Question 3

Gadolinium

Answer 3

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)

Question 4

Barium swallow vs modified barium swallow (fluoroscopic contrast studies)

Answer 4

Live x ray fluorscopy with water soluble substance (typically barium), either directly or modified (in a cracker, assessing the oropharygeal phase of swallow)

Question 5

CT is better for ___ visualization, MRI is better for ___ or ___, MRA is best for ___

Answer 5

Bone, soft tissue, nerve, vascular

Question 6

MRI advantages (2) and disadvantages (3)

Answer 6

\+no radiation
\+good soft tissue visualization
-more expensive
-long time to stay still (may require sedation, CT's are super quick)
-pregnancy contraindicated

Question 7

Generalized pruritis all over can be a sign requiring further evaluation as it may be due to…

Answer 7

….lymphoma

Question 8

Soft tissues typically DO require ____ when using MRI, while hard bony structures do not.

Answer 8

Contrast

Question 9

Sinus X rays are ___ recommended to ever be performed, instead a ___ imaging study is preferred

Answer 9

NOT, CT

Question 10

FEES

Answer 10

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)

Question 11

Sialogram of parotid

Answer 11

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

Question 12

Plain vs doppler ultrasound

Answer 12

Doppler ultrasound sees the flow of blood unlike a plain

Question 13

Normal vs non normal lymph nodes on ultrasound

Answer 13

Oval and fat filled deposits (appear as discoloration within the lumen on ultrasound) are normal while non normal tend to be round and dark

Question 14

PET scan

Answer 14

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)

Question 15

Radioactive Iodine uptake scan

Answer 15

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

Question 16

Iodine doesn’t just isolate to the thyroid but also the…

Answer 16

…salivary glands (if using radioactive iodine uptake scan must keep fluids to push it and avoid xerostomia as an unpleasant side effect)

Question 17

Hereditary hemorrhagic telangectasias (HHT)/osler-weber-rendu disease

Answer 17

AV vascular malformations that can occur anywhere in mucosal surfaces of the body and result in large bleed putting at risk often requiring intervention

Question 18

Videostroboscopy

Answer 18

Visual assessment of various vocal cord conditions and abnormalities thru mouth or nose, gold-standard in laryngological diagnostic care

Question 19

Parts of the jaw (parasymphyseal/mental, body, angle, ramus, condyle, and coronoid process)

Answer 19

• 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)

Question 20

Mandible condylar fracture common causes, diagnostic study, and treatment

Answer 20

• 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)

Question 21

Mandible ramus fracture

Answer 21

Sees condyle displacement within the joint and often occurs with counter fracture on opposite side, have a weak bite, treated with surgical intervention

Question 22

Mandible angle fracture

Answer 22

Occurs near the wisdom teeth and thus may require extraction due to root death potentially

Question 23

Lefort I-III

Answer 23

-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)

Question 24

Midface fractures often result from…

Answer 24

…often resultant from car accidents or falls

Question 25

Presbyesophagus

Answer 25

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

Question 26

Zenker diverticulum

Answer 26

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

Question 27

Steeple sign

Answer 27

A sign on x ray of narrowing of trachea indicative of croup (laryngotracheobronchitis)

Question 28

Thumb print sign

Answer 28

A sign of epiglotitis seen on a lateral x ray of the head

Question 29

Hot potato voice

Answer 29

A characteristic sign of epiglotitis or peritonsillar abscess seen in someone with a thick and muffled voice

Question 30

Outbowing of ethmoid sinuses is commonly seen on CT and is a sign of….

Answer 30

….nasal polyps

Question 31

Invasive fungal sinusitis vs allergic fungal sinusitis (mycetoma)

Answer 31

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

Question 32

Orbital extension of ethmoid sinusitis

Answer 32

Abscess formation that pushes into the orbit from the ethmoid sinus

Question 33

Proptosis often requires ____ imaging study to rule out serious pathology

Answer 33

CT imaging of head

Question 34

Concha bullosa

Answer 34

An enlarged middle turbinate seen in approx half the population that can be resected if causes issue such as congestion or runny nose

Question 35

Patients with nasal polyps (mucus retention cysts) present completely…

Answer 35

…asymptomatic

Question 36

Thyroglossal duct cyst origin and sign

Answer 36

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

Question 37

Why is it important to remove part of the hyoid bone when treating a thyroglossal duct cyst via surgical removal?

Answer 37

Part of the duct travels thru the hyoid bone in order to prevent remnants of the cyst from remaining (sistrunk procedure)

Question 38

cricopharyngeus

Answer 38

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