Page 19 Flashcards
T1 and T2 signals of chronic noninvasive aspergillus sinusitis and chronic allergic hypersensitivity aspergillus sinusitis?
hypo T1 and T2
Site of Isolated obstruction of the maxillary sinus?
infunfibulum (of the maxillary ostium)
Combined obstruction of the ipsilateral maxillary, anterior and middle ethmoid, and frontal sinuses?
ostiomeatal pattern of obstruction / hiatus semilunaris (middle meatus)
Where do inverting papillomas occur exclusively?
lateral nasal wall, centered on the hiatus semilunaris
What ca are inverted papillomas associated?
SCC
Retromaxillary pterygopalatine fossa (adjacent to the sphenopalatine foramen) location is a hallmark feature
Juvenile nasopharyngeal angiofibroma
High within the nasal vault, involvement of the cribriform plate with extension into
anterior cranial fossa
Esthesioneuroblastoma
Where are minor salivary glands most highly concentrated?
palate
Superior recess of tympanic membrane between the scutum and neck of the malleus, where pars flaccida cholesteatomas arise
Prussak space (medial to pars flaccida - b/w scutum and neck of malleus)
Destructive midline bony mass centered in the clivus with predilection for the
sphenooccipital synchondrosis (horizontal line in the midclivus - sag view)
chordoma
Prior radiation or from malignant transformation of Paget dse
Osteogenic sarcoma
Trabecular coarsening w/o bony destruction
Paget disease
CT moth-eaten destruction /MR salt and pepper signal of jugular fossa
Glomus jugulare
Petrous apex: bright T1, bright T2
Cholesterol granuloma (because of cholesterol and hemorrhage)
Petrous apex: dark T1, bright T2, no enhancememt
retained fluid secretions (fluid signal)
Petrous apex: dark T1, bright T2, ring enhancememt
Petrous apicitis (just like abscess)
Petrous apex: bright T1, dark T2, no enhancement
Nonaerated petrous apex (normal marrow signal)
Early triad of radiographic findings in mucosal space malignancies
- superficial nasopharyngeal mucosal asymmetry
- ipsilateral retropharyngeal adenopathy
- mastoid opacification
Narrow the stylomandibular notch?
carotid space masses
Widen the stylomandibular notch / Push styloid process and carotid vessels posteriorly?
deep parotid space lesions
Danger space?
retropharyngeal space
How do you call paragangliomas arising from Arnold and Jacobson nerves? glomus tympanicum tumors Difference of schwannomas and neurofibromas as carotid space tumors:
schwannomas - encapsulated, do not infiltrate substance of nerve; neurofibromas - not encapsulated, multiple, permeate substance of nerve fibers
Characteristic low-intensity center on T1, involve >1 peripheral nerve
neurofibromas
Which head and neck nodes may normally measure up to 1.5 cm?
jugulodigastric and submandibular nodes
Proclivity for perineural spread w/c serves as a hallmark? (3)
Fungal, SCC, adenoid cystic ca
What MR sequence can best visualize lymph nodes?
T2 fat sat, Gd: normal LNs-homogeneous, fatty hilum; abnormal LNs-heterogeneous, +cystic change, +necrosis
Highest node of the IJC?
jugulodigastric node
What are features suggestive of malignancy and/or infection?
Peripheral enhancement with central necrosis, extracapsular spread with infiltration of adjacent
tissues, matted conglomerate mass of nodes
What structure the intra and extraconal spaces?
muscle cone or annulus of Zinn
How can you differentiate benign from metastatic enlarged LN based on shape?
Rounded form-suggests neoplastic nodal infiltration; reniform shape-most likely benign reactive change
Extensive thickening of the perioptic meninges reflecting peritumoral-reactive meningeal change, common in NF
arachnoidal hyperpasia / gliomatosis
lymphangioma lam mo na
<1 yr, regress after 1-2 yrs, infiltrative, flow voids
capillary hemangioma
Where does the apex of the muscle cone lie?
SOF
adults, sharply circumscribed, rounded, diffuse enhancement, mottled pattern
cavernous hemangioma
venous
varyx
Extraconal lesion with lipid content as a characteristic finding
dermoid
Unilateral globe diseases in the pedia
ocular toxocariasis, Coats disease (bilateral - retinoapthy of prematurity and persistent hyperplastic primary vitreous tumour
How can we differentiate recurrence from fibrosis?
Recurrence-high T2, fibrosis-low T2
What are helpful US signs of thyroid enlargement?
Thickening of isthmus >3mm, outward bulge of anterior surface of gland
What US finding is highly indicative of papillary thyroid carcinoma?
Punctate echogenic foci (microcalcification)
This diffuse thyroid disease causes progressive fibrosis that eventually destroys the gland
Reidel’s thyroiditis
What diffuse thyroid disease shows striking diffuse increased vascularity, aka thyroid inferno?
Graves disease
What accounts for about 90% of congenital neck lesions?
Thyroglossal duct cys
Thyroglossal duct normally involutes at what AOG?
8-10 weeks
What is the usual course of the thyroglossal duct?
Foramen cecum (tongue base), anterior to thyrohyoid membrane & strap muscles, thyroid isthmus
What is the imaging modality of choice to determine the full extent of TDC?
Sagittal MR
When do laryngoceles present as a neck mass?
When it protrudes above the thyroid cartilage through the thyrohyoid membrane, presents as a lateral neck mass near the hyoid
In patients with laryngoceles without a known risk factor, what should be suspected?
? Underlying neoplasm obstructing the laryngeal ventricle
What is the main cause of laryngocele formation?
Chronically increased intraglottic pressure, as in excessive blowing or coughing
What are the differentials for TDC?
Necrotic anterior cervical LNs, thrombosed IJV, abscess, obstructed laryngocele
What are the diagnostic features of a laryngocele?
Communicates with laryngeal ventricle, found deep to the strap muscles
How do you classify laryngoceles?
Internal, external, mixed - accdg to relation to thyrohyoid membrane
What is one way we can differentiate TDC from laryngoceles?
TDC are either superficial or embedded within the strap muscles; laryngoceles are found deep to strap muscles
Majority of branchial cleft anomalies arise from which branchial cleft?
2nd branchial cleft
How does a branchial cleft cyst usually present?
Painless neck mass anterior to SCM
What are syndromes associated with fetal cystic hygromas? 3
Turner, Noonan, fetal alcohol syndrome
Lymphangiomas can be classified into these 3
capillary, cavernous, cystic
What are the differentials for BCC?
Necrotic LNs, abscess, cystic neural lesions, thrombosed vessel
Where are lymphangiomas commonly located
Posterior triangle of the neck
What are characteristic imaging findings of lymphangiomas?
Transspatial disease, heterogeneous T2 signal, multiloculated cystic masses with septations, +hemorrhage +fluid, compressible, does not displace adjacent structures
