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SON5020 > Neck and Associated structures > Flashcards

Neck and Associated structures Flashcards

1
Q

How would you improve the scanning of small lesions?

A
  • Use light pressure
  • Thick layer of gel
  • Gel standoff
  • Mobilise mass with fingers
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2
Q

Describe a thyroglossal duct cyst

A

A thyroglossal duct cyst is the most common developmental cyst in the neck. It develops from epithelial lined remnants of the embryonic thyroglossal duct. They can appear between the base of the tongue and the suprasternal region, most lying between the hyoid bone and thyroid cartilage. Cyst development and enlargement are in response to repeated local infection and inflammation. They are usually in the midline or slightly off centre and move superiorly with swallowing. Patients usually present with no pain.

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3
Q

Describe the U/S appearance of a thyroglossal duct cyst

A
  • Well-circumscribed mass of 2-4cm with variable appearance dependent on level of infection, number of episodes
  • Anechoic with posterior enhancement
  • Homogeneously hypoechoic with fine internal echoes
  • complex with coarse, irregular internal echoes and septae
  • Solid with little to no posterior enhancement
  • Debris due to viscosity of fluid, infection of haemorrhage
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4
Q

Describe a branchial cleft cyst

A

Most branchial cleft cysts develop from the 2nd branchial cleft. They are typically positioned laterally near the angle of mandible, under the anterior margin of the sternocleidomastoid muscle, superficial to the CCA and IJV. Sinus tracts may occur. Two common presentations are after an URTI or post-traumatic incident.

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5
Q

Describe the U/S appearance of a branchial cleft cyst

A
  • unilocular and well defined
  • a beak may be seen
  • anechoic with posterior enhancement
  • diffuse low-level echoes/debris with little posterior enhancement
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6
Q

Describe an abscess/cellulitis

A
  • Most common in immuno-suppressed patients
  • Maybe as a consequence of suppurative adenopathy, salivary gland infection, dental abscess, post radiotherapy
  • Ill-defined irregular collection with thick wall and internal debris
  • u/s assisted drainage may be required
  • May appear as loss of fascial planes and associated inflammatory cervical lymphadenopathy
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7
Q

Describe a laryngocele

A
  • Rare
  • Cystic mas/sac in the larynx
  • Associated with laryngeal tumours
  • Associated with regular forced expiration eg. woodwind player
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8
Q

Describe a lymphangioma/cystic hygroma

A
  • Neonates/young children

- Cystic masses with thin internal septae supero-laterally in the neck

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9
Q

Describe a dermoid cyst

A
  • rare
  • midline, slightly off midline in sublingual or submental region of the neck
  • well-circumscribed and echogenic mass
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10
Q

Describe a sebaceous cyst

A
  • common in the posterior neck
  • well circumscribed with well defined anechoic or low level internal echoes
  • posterior enhancement
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11
Q

Describe a lipoma

A
  • benign
  • encapsulated lesions that are often palpable
  • commonly occur int he superficial tissues of the head and neck
  • tend to displace adjacent structures rather than infiltrate
  • compressible, well-defined and usually elliptical
  • hyperechoic mass compared to adjacent muscle
  • heterogeneous internal echoes with linear stranding
  • no posterior enhancement or shadowing with no significant vascularity
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12
Q

List types of masseter muscle pathology

A
  • abscess
  • tumour
  • haemangioma
  • muscle hypertrophy
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13
Q

Describe schwannoma and neurofibromas

A
  • hypoechoic
  • heterogeneous solid mass with posterior enhancement
  • well-defined (benign)
  • ill defined can indicate malignant change
  • adjacent nerve may be thickened
  • schwannomas are normally more vascular than neurofibromas
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14
Q

Describe paraganglioma/chemodactomas

A
  • arise from neural crest cells of the vessel walls
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15
Q

Describe carotid body tumours

A
  • Rare
  • present as a pulsatile, painless mass in the anterior triangle, near the angle of the mandible
  • may be bilateral
  • associated with other head paragangliomas
  • located at the common carotid bifurcation and splays the internal and external carotid arteries
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16
Q

Describe the U/S appearance of carotid body tumours

A
  • Well defined
  • hypoechoic compared to adjacent structures
  • solid
  • does not calcify
  • variable internal vascularity
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17
Q

Describe a carotid artery bulb

A
  • heavily calcified bulb or carotid artery aneurysm
  • may be palpable
  • often pulsatile
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18
Q

Describe the causes of a jugular vein thrombosis

A

Can occur as a consequence of indwelling pacemakers, central venous lines, trauma, surgery, infection, IVDU, compression by tumour, mediastinal lymphadenopathy

19
Q

Describe the appearance of the a jugular vein thrombosis

A

Acute= pain, fever, tender, swelling

Chronic- painless, hard mass

20
Q

Describe the ultrasound appearance of a jugular vein appearance

A

Acute- appears as ill-defined fascial planes with echogenic matter wihitn the vein, non-compressible, no flow with valsalva
Chronic- normal fascial planes, thrombus well-organised and echogenic

21
Q

Why would you get a jugular vein thrombosis?

A

Inflammatory or infiltrative cervical lymphadenopathy

May be tumour thrombus associated with follicular or anaplastic carcinoma of thyroid

22
Q

Describe the normal appearance of cervical lymph nodes

A

A normal lymph node is 2-5mm in diameter. Tonsillar lymph nodes are normally larger. Most normal nodes have a flattened, elongated, oval shape with a length:width ratio >2. They are usually hypoechoic with a fatty hilum

23
Q

Describe the appearance of reactive or suspicious lymph nodes.

A

String of pearls appearance along the jugular vein of enlarged lymph nodes.
Malignant nodes tend to be round with a length:width ratio <1.5. They can be hypo-isoechoic with an obliterated fatty hilum. They can take on features of the primary with variable blood flow. They may have undergone necrosis and appear cystic.

24
Q

What are the salivary glands?

A

parotid, submandibular and sublingual- they are responsible for a large portion of total saliva

25
Q

Where is the parotid gland?

A
  • Lying in parotid fossa bounded by mandible and masseter muscle anterior and mastoid process, SCM and digastric muscle posteriorly
  • Superficial and deep lobes by the facial nerve
  • Superficial lobe may run over the top of the masseter muscle
  • Deep lobe extends behind the ascending ramus of the mandible
    • Hard to see on ultrasound
  • Can have lymph nodes due to late encapsulation
26
Q

Describe the parotid duct

A

The parotid duct is 5cm in length and runs over the masseter muscle. It pierces the buccinator muscle to open into the mouth. The diameter is 3mm.

27
Q

Where is the sublingual gland?

A
  • Sublingual glands lie anterior to the submandibular gland deep to the mylohyoid muscle
  • No intraglandular lymph nodes due to early encapsulation
28
Q

Describe the submandibular gland

A

The submandibular gland is approximately 5cm. It curves along the mylohyoid muscle and runs parallel to the tongue under the mucosa of floor of mouth. It opens into the oral cavity. The duct has a normal diameter of 2-3mm

29
Q

Describe the u/s appearance of the salivary glands

A

The parotid has a slightly greater echogenicity compared to the submandibular. It is homogeneous with mid-level echoes. Blood vessels may be hypoechoic. Non-dilated ducts are thin echogenic lines within the superficial gland. Intraglandular ducts and short, echogenic lines. Intraparotid nodes are often seen (5mm diameter within echogenic hilum). Facial nerve is not often seen. Retromandibular vein runs close to the parotid glands.

30
Q

What happens after eating when there is a salivary duct obstruction?

A

A salivary duct obstruction causes the gland to increase in size while eating.

31
Q

Describe the exam technique for the salivary glands

A
  • Imaging deep section of parotid gland is difficult
  • Visualising posterior belly of digastric muscle ensures all of deep parotid gland is seen
  • Lower the frequency for better penetration
  • Neck rotation to help scan deep portion
  • Most tumours appear to the superficial portion
  • Scan both sides for symmetry to exclude bilateral disease
  • Intra-oral imaging to examine the duct ampulla
32
Q

What are the pitfalls of scanning the salivary glands

A
  • Poor visualization of deep parotid gland
  • Intraparotid node can be confused for a tumour
  • Difficult to assess origin of large masses
  • Submandibular calculi can be mimicked by trapped air bubbles
  • Difficulty to image the duct ampulla
  • May not be able to see sublingual or minor salivary glands unless enlarged
33
Q

Describe sialosis

A

Non-tender, recurrent enlargement of the parotid gland
Gland hypertrophy and subsequent fatty infiltration
Commonly occurs in malnutrition, alcholism, diabetes
Enlarged, echogenic gland with fine texture

34
Q

Describe ranula

A

Mucous retention cyst of the sublingual and minor salivary glands
Simple ranula most common
Simple ranula may rupture into submandibular space, forming a pseudocyst
Diving/plunging ranula- extends below mylohyoid

35
Q

List salivary gland congenital anomalies

A

Cyst of the 1st branchial cleft present within the parotid gland
Lymphangioma
Haemangioma

36
Q

List salivary gland tumour

A

Parotid gland due to anterior, superficial portion of gland
Haematoma
Fistula
Sialocele

37
Q

Describe salivary gland calculi

A 
Sialolithiasis within the gland
Sialodocholithiasis within the duct
Involves submandibular gland
Submandibular saliva has greater mucous content than parotid
Single or multiple
Can be radiopaque
38
Q

Describe ductal dilation

A

When dilated, easily seen
May be due to calculi, tumour or stricture
Dilated duct >2mm

39
Q

Describe salivary gland tumours

A

Palpable mass
More common in parotid gland
Likely benign
In submandibular and sublingual glands, greater chance of being malignant
Mass in children likely to be malignant
Tumour in parotid may be lymph node related
Malignant nodes more common than malignant tumours
Malignant tumours present as hard mass, facial nerve paralysis and cervical lymphadenopathy
Biopsy required

40
Q

Describe benign pleomorphic adenoma

A 
Mixed salivary tumour
Most common salivary gland tumour
Slow-growing, smooth, non-tender
Malignant change- rapid growth
Hypoechoic, homogeneous mass with lobulated sharply marginated borders
41
Q

Describe warthin tumour

A

Second most common benign tumour of parotid
Multiple and bilateral
Originates within intraparotid lymph nodes
Slow growing
Smoot swelling
Well-circumscribed hypoechoic mass, may be heterogeneous

42
Q

Describe a primary malignant salivary tumour

A

Hypoechoic
Small, well-circumscribed, some may be ill-defined
Larger tumours are heterogeneous due to necrosis and hemorrhage with ill-defined margins
Disorganised flow with high resistive spectral trace

43
Q

Describe mucoepidermoid tumour

A

A Most common malignant salivary tumour
Occurs at any change
Common in children

44
Q

Describe cylindroma

A

A Most common malignant tumour of salivary gland
Usually affects salivary glands more than parotid
Most common in submandibular
May infiltrate facial nerve
Single, rounded, hypoechoic mass

SON5020 (5 decks)

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