Lecture 3 - Miscellaneous Radiopacities Flashcards
What can you see on a radiograph?
Tooth
Bone
Calcification
Foreign bodies
Sialolith
Calcification of salivary gland
Most commonly in Wharton’s duct of submandibular gland
Sialolith Clinical Features
Intermittent pain (worse before mealtimes) Intermittent swelling Palpable and tender Xerostomia if complete obstruction Can cause infection
Sialolith Radiographic features
~50% radiopaque
Located at site of salivary glands
Sialolith Ddx
Mucous plug
Lymph Node Calcification Clinical Features
Calcification in chronically inflamed LN
Asymptomatic
More common in submandibular and cervical nodes
Lymph Node Calcification Radiographic Features
Multiple lobules
Cauliflower shaped
Runs down cervical chain
Lateral and anterior to nasopharynx
Lymph Node Calcification DDx
Idiopathic
Tuberculosis
Carotid artery calcification (more posterior)
Sialolith (smoother and symptomatic)
Phlebolith (smaller, multiple, radiolucent ring)
Carotid Artery Calcification
Monckeberg’s Medial Calcinosis (arteriosclerosis)
or
calcified atherosclerotic plaque
Carotid Artery Calcification Clinical Features
Initially asymptomatic Vascular insufficency may lead to: -cutaneous gangrene -peripheral vascular disease -myositis
Carotid Artery Calcification Radiographic Features
Calcification in front of vertebrae
Monckeberg’s Medial Calcinosis appears as thin line “tram-track” appearance
Calcified atherosclerotic plaques appear as multiple, irregularly shaped califications near the hyoid bone
Carotid Artery Calcification DDx
Calcified triticeous cartilage (uniform size and shape, in laryngeal cartilage skeleton, innocuous)
Tonsillolith Clinical Features
Calcified material in tonsils (most commonly palatine tonsils)
Mostly asymptomatic
May cause pain when swallowing
May cause halitosis
Tonsillolith Radiographic Features
On PAN, appear higher than actual tonsils
Tonsillolith DDx
Dense bone island Foreign body Calcified granuloma Malignancy Enlarged temporal styloid process
Anthrolith
Mineralized masses in maxillary sinus
Extrinsic (entered the sinus) or Intrinsic (mineralized within the sinus)
Anthrolith Clinical Features
Usually asymptomatic Incidental findings on radiograph Sinusitis Blood-stained nasal discharge Nasal obstruction Facial pain
Anthrolith Radiographic Features
Located in maxillary sinus Well-defined periphery Smooth or irregular shape Free-floating, not attached to sinus wall May have radiolucent center
Anthrolith DDx
Root fragment in sinus (check for root canal)
Rhinolith (calcifications in nasal fossae, determine location w/ PA and lateral skull views)
Phlebolith
Calcified thrombi in veins, venules, or sinusoidal vessels of hemangiomas.
Caused by venous stagnation.
Occur in multiples
Phlebolith Clinical Features
In head and neck: usually indicates a hemangioma
Soft tissue can be swollen, throbbing, and discolored
Tissue blanches with pressure
Bruit with auscultation (if cavernous hemangioma)
Phlebolith Radiographic Features
Commonly located in hemangiomas
Round or oval cross-section, follows shape of vessel
s-eye laminations
Phlebolith DDx
Sialolith (usually singular)
Osteoma Cutis
Rare soft tissue ossification of the skin
Only treated for cosmetic reasons
Osteoma Cutis Histologic Features
Dense viable bone in the dermis or subcutaneous tissue
Osteoma Cutis Radiographic Features
Located in the skin (cheek and lip)
May overlay tooth root or alveolar process
Smooth, washer-shaped (donut appearance)
Single or multiple
0.1-0.5 cm
May have radiolucent center (normal fatty marrow)
Osteoma Cutis DDx
Myositis ossificans (usually greater proportions) Calcinosis cutis Osteoma mucosae (usually deeper)
Rhinolith
Calcification in nose
Arises from deposition of nasal, lacrimal, and inflammatory mineral salts
Also from foreign bodies (mostly kids)
Rhinolith Clinical Features
Usually asymptomatic
Mass can expand, impinge on mucosa, and cause pain
Stylohyoid Ligament Calcification/Ossification
Usually bilateral
Ossification usually extends downward from base of skull
Detectable by palpation
Usually asymptomatic
Eagle Syndrome
Subtype of Stylohyoid Ligament Ossification
History of trauma (tonsillectomy)
Cranial nerve impingement (V, VII, IX, X, or XII)
Vague pharyneal pain on swallowing, turning head, or openning mouth
Tinnitus or otalgia (ear ache)
Stylohyoid Ligament Ossification Radiographic Features
Seen on PAN
Thin, linear opacity extends forward from the mastoid process and crosses postero-inferior aspect of ramus towards the hyoid bone
