Module 6: H + N (not spine) Flashcards
petrous apex
can get asymmetric marrow
what MRI sequence is useful and why
STIR fat satruation.
remove fat, can show a cholestrol grnauloma which might otherwise be hidden
Cephaloceles
what is it
herniation of CNS content through a cranium defect
two important carotid artery variant anatomy to be aware of
stapedial artery
aberrant internal carotid
what is the most common petrous primary lesion
cholestrol granuloma
cholestrol granuloma on MRI
T1 and T2 bright
T2 dark haemosiderin ring
what is a cholestrol grnauloma made from
blocked air cells with haemorrhage and inflammation continuining
What is a cholesteatoma
epidermoid (ectopic epithelial tissue)
congenital
How to define a choleastoma from a cholestrol granuloma
T1 dark for choleastoma and restrict diffusion
granuloma T1 and 2 are bright
otomastoiditis
trigeminal neuropathy
lateral rectus palsy
grandenigo syndrome
Endolymphatic sac tumour
ax to what condition
grow into where
how will they appear on CT
MRI?
vHL
CPA
calcifcaiton on CT
MRI - T2 bright
Paraganglioma in jugular region present with q
hoarse voice from vagus nerve
Large vestibular aqueduct syndrome is what
bony canal between vestibulae(inner ear) and endolymphatic sac.
enlarged causes progressive sensorineural hearing loss
VA vs PSCC size
in vestibular aqueduct syndrome
normall VA is not larger than the PSCC.
MRI appearance of labyrinthitis
inflammation of the membranous labyrinth.
cochlea and semicircular cancals enhance on T1 post contrast
what happens in layrinthitis ossificans
ossification of the membranous labyrinth
causes sensori neural hearing loss
two types of otosclerosis
fenestral
retrofenestral
Fenestral otosclerosis
bony resorption anterior to the oval window,
Footplate will fuse to the oval window
Retrofenstal otosclerosis
more severe form.
demineralization around the cochlea.
sensori neurla component. Bilateral and symeetric nearly 100% of the time
otitis media is infection where
middle ear
effusion
why do downs more commonly get otitis media
horizontal eustachian tube
definition of chronic for otitis media
6 weeks of fluid
complications of otitis media
coalescent mastoiditis
facial nerve pasly
dural sinus thrombosis
meningitis and labyrinthitis
Labyrinthine fistula can result from
a cholesteatoma
lateral semicircular canal most often involved in a fistula
superior semicircular canal dehiscene can cause
noice induced vertigo
causative bug of necrotising external otitis
pseudomonas
which bits of the facial nerve don’t enhance
cisternal
canalicular
labyrinthine
what can cause abnormal enhancement of the facial nerve
Bells palsy
Lymes
Ramsay hunt
Cancer
what are some compication of the pagets skull
deafness
cranial nerve paresis
if invading basilar, brainstem compression
high grade osteosarcoma
age variation of pagets vs fibrous dysplasia
pagets is over 80
Fibrous dysplasia is under 30
location variaton of pagets vs fibrous dysplasia
Fibrous dysplasia spares the otic capsule
What do McCune albright syndrome get
multifocal fibrous dysplasia
cafe au lait spots
precocoiuos puberty
Juvenile nasal angiofibroma is found on the ….
get expansion of the
sphenopalatine foramen
expansion of the pterygopalatine fossa
Juvenile nasal angiofibroma get blood supply fomr
ascending pharnygeal artery and internalmaxillary
inverting papilloma are found where
lateral wall of the nasal cavity
appearance of an inverting papilloma
focal hyperostosis at the tumour origin
Esthesioneuoblastoma is found where
….. and therefore appearance is
starts at cribiform plate
dumbell appearance
most common location for squamous cell sinuses
maxillary antrum
squamous cell sinuses mri appearance
low T21 due to packed cells.
with epistaxis, posterior bleeds can be N-IR embolised via what vessel
sphenopalatine artery.
with embolising nose bleeds what to watch out for
variant anastomosis between the ECA and opthalmic artery.
don’t want to embolize the eye
dermoid /epidermoid in the floor of the mouth has what appearance
sack of marbles
what is a Ranula
in the mouth
mucous retention cyst
Torus palatinus can be mistaken for what
cancer as it looks nasty
just bone overgrowth at the hard palate
Ludwigs angina is what (mouth)
aggro cellulitis.
gas everywhere
starts from odontogenic infection
What are the classical associated causes of ON of the mandible
bisphosphonates
radium paint licking
radiation
thyroglossalo duct cyst can appear where?
anywhere between the foramen cecum and the thyroid gland
thyroid nodules
microcalcificaitons think
papillary thyroid cancer
thyroid nodules
comet tail
colloid nodule
cause of large thyroid in UK vs AFrica
graves
africa likely low idoine
how does graves cause hyperthyroidims
antibodies directed towards tsh receptor
orbit and graves featurs
spares tendon insertion
IMSLO
Increased intra-orbital fat
hashimotos can cause increased risk of
primary thyroid lymphoma
what are the antibodies in Hashimotos
TPO and antithyroidglobulin
Level 6 node - delphian - think
laryngeal cancer met
subacute thyroiditis / De Quervains can be in repsonse to
upper airway infeciton
Reidels thyroiditis is one of what tpye of conditions
igG4 conditions
WHAT ARE THE OTHER iGg4 CONDITIONS
Orbital pseudo tumour
retroperitoneal fibrosis
sclerosing cholangitis
Papillary is…
popular
most common
Papillary cancer seen on imaging
microclacifications
How does follicular cancer metastatis
via blood
Medullary thyroid cancer is associated with what
MEN2
Medullary thyorid produces what
calcitonin
DOes medullary cancer respond to I-131
no
ANaplastic thyroid seen in
elderly
not repsond to i131 due to heavy differnetiation and no sodium idoine transporters
parathyroid anatomy
superior 2 from 4th branchial pouch
inferior 2 are from the 3rd
what are the causes of hyperparathyroidism ?
Hyperfunctioning adenoma
Multi-gland hyperplasia
Cancer
What factors does sestamibi prathyroid imaging depend on ?
mitochondrial density and blood flow
the partodi space contains
parotid gland
cranial nerve 7
retromandibular vein
Pleomorphic adneoma
MRI appearance
T2 bright
can be in parotid, submandibular and sublingual
Warthins will normally affect who
male
bilateral, smoker
most common malignant tuimour of the minor salivary glands
mucoepidermoid carcinoma
adnoid cystic carcinoma love what kind of spread
perineural
neural foramen widerning - what type of malignancy is ax
schwannoma
bilateral parotid lymphoma diagnosis
Sjogrens
benign lymphoepitheliam disease seen in which dieases
HIV
what exists in the carotid space?
carotid artery
jugular vein
portions of CN9,10,11
Internal jugular chain lymph nodes
what are the classic carotid space tumours
paraganglioma
schwannoma
neurofibroma
what are the three paragangliomas and how to differentiate them
Glomus Tympanicum - confined middle ear
GLomus jugulare - skull base
Glomus vagale - below Jugular formane
Nuclear medicine for paragangliomas is
In - Octreotide avid
what is Lemierre syndrome
thrombophlebitits of jugular veins.
distant metatstatic sepsis.
get in recent ENT surgery or oropharyngeal infection
a masticator space mass - most commonly is a
odontogenic infeciton
if there is a masticator space infection where to look
bone windows at the mandible
spread via the pterygopalatine to orbital apex and cavernous sinsu
perineural spread you think
adneoid cystic minor salivary tumour
melanoma
where does the retropharyngeal space sit
behind the middle layer of the deep cervical fascia
anterior to the alar fascia
what is the danger space
potential space, behind the alar fascia
only if distended
what is bad about danger space
can track to the mediastinum
Necrotic nodes can be due to
supparative infection
SSC mets
What is Griesels syndrome
Torticollis from atlanto axial joint inflammation or retropharyngeal abscess
relevance of the parapharyngeal space
based on its displacement can work out where there mass elegion is arsing from other areas
what seperates neck segments 1a and 1b
anterior belly of digastric
what seperates 1b from 2a
stylohyoid muscle
what spereates 2a from 2b
spinal accessory nerve
most common location for an nasopharyngeeal SCC
fossa of rosenmuller
unilateral mastoid opacification can be due to
SCC at the fossa of rosenmuller
laryngeal scc - fixation of the vocal cords indicates a
T3 tumour
laryngocele - what is
laryngeal saccule dilates with fluid or air
due to obstruction (15% of the time due to tumour)
if there is an expanded vocal cord ventricle - what to do next
look at the AP window for damage to the recurrent laryngeal nerve
bilateral Coloboma is a part of what syndrome
CHARGE
What is charge snydomr e
Coloboma
Heart
GU
Ears
coats disease
retinal telangiectasis
how to differentiate Coats disease and retinoblastoma
coats small globe and NO calcification
tram track on the optic nerve think
Meningioma
Optic nerve gliomas if bilateral think
NF1
Orbital pseudotumour - features to distinguish it
lateral rectus
Painful
unilateral
doesn’t spare the myotendinous insertions
MRI T2 dark
how to treat orbital pseudotumour
steroids
Tolosa hunt syndrome found where
cavernous sinus
Lymphocytuc hypophysitis
same as orbital pseudotumour but on pituitary gland
most common benign congenitla orbital mass
dermoid
fat containing
most common extra occular orbital malignancy in kids
rhabdomyosarcoma
breast cancer mets to the orbits cause what
enopthalmos due to desmoplastic reaction
two types of globe tumours are
Melanoma
retinoblastoma
varix vs lymphangioma
varix distent with valsalva
lymphangioma have fluid fluid level
NF1 patients can get pulsatile exopthalmus frommmmmm
sphenoid wing dysplasia
what is dacrocystitis
inflammation of the lacrimal sac
anterior spinal artery arises from where
termination of the vertebral arteries.
what is the artery of adamkieicz
reinforcer of the anterior spinal artery.
comes off left aorta between T8 and T1.
supplies lower 2/3
posterior spinal artery arises from where?
vertebral arteries or the posterior inferior cerebellar artery.
discontinous throughout
conus medullaris: temrinates at L2/ L3 think
tethered cord
epidural space in the cervical cord vs the lumbar spine
cervical cord mostly venous plexus
in the lumbar spine its mostly fat
focal henriation
less than 90 degress of disc circumference
boradbased herniation
more than 90
protrusion vs extrusion
to do with the base width
what is a schmorl node
herniation of disc material through a defect in the vertebral body endplate into the actual marrow
what is scheuermanns
multi level Schmorls nodes in the spine of a teenager
kyphotic demority.
what is a limbus vertebra
fracture mimic
herniated disc material between non fused apophysis and adjacent vertebral body
what are the modic changes that can happen in the lumbar spine
edema
fat
scar
describe the modic change based on differing MRI signals
T1 - edema. T1 dark, T2 bright.
2 - fat - T1 and T2 bright
T3 scar - T1 and T2 dark
annular tears on MRI
appearance is
T2 bright and curvilinear look
complications post spine surgery
arachnoiditis is seen as what on imaging
cclumped nerve roots. Empty thecal sac.
post 6 weeks is abnormal.
Conjoined nerve roots
two nerve roots sharing an enalrge common sleeve
scar vs residual disc post operatively
how to tell
with contrast
scar will enhance
Hangman fracture is caused by
hyperextension
bilateral pedicle or pars fracture
Chance fracture is found where
Horizontal fracture through the thoracolumbar spine
seatblet injury
Jefferson fracture
burst C1
axial load
odontoid fracture classications
1 - 3
1 - top
2 - base
3 - body of C2
only 1 is stable (maybe) - others unstable
felxion teardrop in spine fracture is found where
anterior inferior vertebral body
concern of a teardrop fracture
extensive underlying ligamentous injury
instability !
anterior cord syndrome
what happens
motor function and anteiror column snesiaton is gone
inverted hambruger sign on axial imaging
unilateral facet dislocation
benign vs malignant
retropulsed fragment
benign!
convex posterior vertebral body cortex think
malignant
terminal ventricle in the spine whatn
development variant
no complications
normally about 4mm
two types of spina bidifa
open - spinar bifida aperta
closed - occulta
spina bifida: myelomeningoceles are assocaited with what
Chiari II malformations
lipomyelocele are associated with
tethered cord
Closed spinal dysraphisms without a subcut mass
what are they
INtradural lipomas
fibrolipoma
filum terminale (tight)
Dermal sinus
What is the currarino triad
anterior sacral meningocele
anorectal malformation
sacrococcygeal osseous defect
What is diastematomyelia
sagiital split in the spinal cord.
how many types of spinal AVM / AVFs are there
4 types
list types of spinal AVMs/ AVfs
Type 1 - dural AVF (single coiled vessel)
2 - intramedullary nidus (HHT and KTS)
3 - Juvenile - complex and bad
4 - perimedullary (noear conus)
Foix Alajouanine Syndrome
myelopathy ax with dural AVF.
ivory vertebrae and picture frame vertebrae
Pagets
rugger jersey
renal osteodystrophy
hyperparathyroidism
osteopetrosis
H shaped vertebra is
sickle cell
TB in the spine
what can happen to the disc space
it can be spared
calcified psoas abscess think
TB
categorise cord pathology in what 5 categories
Demyelinating
Tumour
Vascular
Inflammatory
infectious
common demyelinating conditions
MS (most)
Neuromyelitis optica
ADEM
Transverse Myleitis
MS lesion s are typcially what length
short
2cm
most common MS lesion site in the spine
cervical spine
if in spine will be in brain 90% of the time
focal inflammation of the cord can be called
Transverse myellitis
where can ADEM occur that you wouldn’t expect in MS
basal ganglia and pons
bilateral symmetrically increased T2 signal in dorsal columns
result of
B12 deficiency
GBS on MRI
enhancement of the nerve roots of the cauda equina
ant more than pos
thickened, enhancing, onion bulb nerve roots
Chronic Inflammatory Demyelinating Polyneuropathy
Timeframe of Chronic Inflammatory Demyelinating Polyneuropathy vs Guillain Barre Syndrom e
8 weeks
Spine
intramedullar tumour types
astrocytoma
ependyomoma
haemangioblastoma
Spine
extramedullar intradural
shwannnoma
meningioma
neurofbiroma
drop mets
Extra dural types of cancer in spine
disc disease, bone tumours, mets, lymphoma
most common intramedullary malignancy adults vs paeds
paeds - astrocytoma
adults - ependymoma
features of astrocytoma in the spine
cervical
ecentric
long segment
Ependyomoma features in spine
lower cord
central
short segment
haemorrhage with a dark cap
haemangioblastoma appearance in spine
lots of oedema
VHL ax
thoracic favoured
what shape do schwannomas make
dumbell around formane
nf1 and Nf2
neurofibromas
schwannomas
neurofibromas are ax with NF1
Schwannomas are ax with NF2
drop mets from
medulloblastoma
most common paeds infratentorial tumour
medulloblastoma
vertebral haemangioma will appear as
corduroy appearance
t1 and t2 bright
osteoid osteoma vs osteoblastoma
SIZE 1.5vcm
where in the spine can you get Giant Cell Tumour
Sacrum
chordoma found in the
sacrum
clivus second
vertebral plana in kid
Eosinophilic Granuloma
