Practice vivas Flashcards
Inverted papilloma
Differential - mucocele (complete opacification by mucous, with bony expansion 2 to drainage obstruction)
Antrochoanal polyp - arise in maxillary sinus and expand posterior nasal cavity and nasopharynx
SCC, olfactory neuroblastoma, other tumour
Arise most commonly in lateral wall of nasal cavity, in proximity to the maxillary ostium. Often extends into maxillary sinus as expands.
High association with malignancy (degenerate to SCC 15% and others), and tend to recur
T2 and T1+ convuluted cerebriform pattern.
40-60, male prediliction
HSV 6, 11
May calcify
SCC with nodes
Look for subtle SCC primary if see nodes
Cervical lymph node groups
1 anterior to submandibular
2 jugular, base of skull to hyoid
3 lower hyoid to cricoid, lateral to medial margin of carotid vessels
4 lower hyoid to clavicle, lateral to carotid, anteromedial to SCM and then scalene
5 posterior triangle
6 pre laryngeal, hyoid to manubrium. Anterior to 3 and 4
7 superior mediastinal, between CCAs, to brachiocephalic level
1a submental b submandibular
5a upper, b lower (cricoid)
Fungal sinusitis
Allergic fungal - chronic, associated with asthma, expansion and possibly erosion
Centrally hyperdense material
Acute invasive fungal sinusitis - not hyperdense, tend to be immunocompromised or diabetic
Chronic invasive
Parapharyngeal space
Parotid and masticator both displace medially (antero and postero respectively)
Carotid space displaces it anteriorly
Retropharyngeal and pharyngeal mucosal space displace it laterally (antero and postero respectively)
Pleomorphic adenoma deep lobe can appear entirely extra parotid. The tumour can also rarely arise from rests in the parapharyngeal space
Parotid gland anatomic pathologies
Deep and superficial lobes, separated by facial nerve (retromandibular vein approximate)
Not truely anatomically discrete - important surgically
Most benign tumours are in superficial lobe (though rarely deep also - e.g. pleomorphic adenoma, which when deep can appear entirely extra parotid, or can arise from rests in the parapharyngeal space) while most malignant involve both
Exclusive deep lobe tumours are rare - use parapharyngeal sapce to help localise
Most common malignant parotid gland tumour
Mucoepidermoid carcinoma (these most commonly arise in parotid gland also) Perineural spread (as with adenoid cystic)
Glomus tympanicum paraganglioma
The most common middle ear tumour
2nd most common head and neck paraganglioma after carotid body
Other common: cholesteatoma, schwanomma
Female prediliction, <40
Pulsatile tinnitis, otalgia, or conductive hearing loss
Arise from Jacobsen nerve at Cochlear promintory (tympanic branch of glossopharyngeal)
Soft tissue mass lateral to cochlear promontory. May destroy ossicles
(glomus jugulare, glomus vagale, carotid body)
T1 salt and pepper
Surgical excision, endovascular embolisation pre-op may reduce bleeding risk
Vascular red mass on exam, retrotympanic
Differential aberrant carotid, tympanic membrane haemangioma
Middle ear tumour
Glomus tympanicum Schwanomma facial nerve Cholesteatoma Cholesterol granuloma SCC or BCC or external meatus Head and neck SCC Parotid gland masses
Petrous apex mass
Mets myeloma Chondroma, chondrosarc Meningioma Schwannoma, cholesterol granuloma, cholesteatoma Apical petrositis LCH
Clival mass
Mets, myeloma, chondrosarc, chordoma
Or intracranial growing into clivus - pituitary macro (can have dural tail), invasive. Meningioma. Craniopharyngioma
Or Naso/pharyngeal growing up - mucocele, SCC, rhabdomyosarc
Papillary thyroid cancer
Mets to nodes c.f. follicular where more rare, but often haematogenous
Follicular cancer and adenoma not differentiated on FNA
Microcalc common
Cavitatory nodes
Medullary tends to have calc in primary and secondary sites (nodes)
Intracranial epidermoid
Present due to mass effect
Can have aseptic meningitis
3rd most common CP angle mass after meningioma and schwannoma
May be seen in other cisterns, or in skull
Diffusion restricts
Do not enhance
Differential arachnoid, dermoid (fat on CT, midline)), inflammatory cyst (neurocystercicosis), cystic tumour (solid enhancement)
Warthins v Pleomorphic
Warthins can be cystic, most common multifocal mass, and doesn’t calcify
Pleomorphic most common mass, may calcify
Warthins tumour only one which favours males. Benign, can excise or follow up with imaging.
Pleomorphics removed because of risk of malignant degeneration (10% at 15 years)
Chordoma
Notochord remants
Sacrococcygeal > spheno-occipital > vertebral
Most common primary malignant sacral tumour
Sacrococcygeal ones are more common in men
Intratumoral calc, moderate to marked enhancement
T2 high, may have haemorrhage
Locally aggressive, recurrence common, poor prognosis. Metastasis uncommon.
Physiliferous cells
Chondrosarcoma
Paramidline cf. Chordoma which are midline
High T2 and rings and arcs calc
Meningioma has low T2 and craniopharyngioma (papillary) doesn’t calcify (Cf. chondrosarc and chordoma)
Antrochoanal polyp
A type of sinonasal polyp
Inflammatory polyp, lined by respiratory epithelium and with inflammatory infiltrate
Arise from maxillary sinus and pass into nasopharynx, expanding
Young adults, sinus symptoms
Maxillary ostium expanded by mass
High T2, with peripheral enhancement
A sinus retention cyst may be indistinguishable from a polyp
JNA
Juvenile nasopharyngeal angiofibroma
Benign but highly vascular
Males almost exclusively
Arise in region of sphenopalatine foramen (posterolateral nasal wall)
Surgery with pre-op embolisation
Prominent T2 flow voids (punctate and serpentine) and enhances
Expanded sphenopalatine foramen with bowed posterior wall of maxillary sinus
Grossly Gray-white tan
Basal ganglia calcification
Idiopathic
Fahrs
Toxic - CO, lead, chemo/rad
Infectious - TORCH, TB, AIDS, cystercicosis, toxoplasmosis
Metabolic - hypo, pseudo, pseudopseudohyp, hyperparathyroidism, mitochondrial disease - MELAS
Dural AV fistula
Usually idiopathic acquired
Most common documented cause is neovascularity from thrombosed dural venous sinus, typically transverse
Those that have cortical venous drainage have risk of bleeding and of neurological compromise. Those that drain direct to sinuses are benign.
Spinal - hypoperfused spine because of venous congestion, intramedullary oedema - conus often involved as dependent, regardless of location of AVF - AVF is most common spinal vascular malformation
Pituitary microadenoma
Dynamic MR delayed enhancement
Laryngeal cancer
Subglottic 5%, late detection and poor prognosis (inferior cricoid to true fold). Spares lymphatics.
Glottic 50-60% manifests early with hoarse voice, and tends not to met because of lack of lymphatic drainage. >90% 5yr survivial
Supraglottic 20-30% early lymph node metastases
Smoking, alcohol, HPV, turkish coffee, asbestos
Myxopapillary ependymoma
Most common tumour of conus / filum WHO1 May have CSF dissemination May haemorrhage, calcify T2 high and enhance
Basal cisterns anatomy
Interpeduncular cistern
Quadrigeminal cistern - between colliculi, splenium, and superior cerebellum
Ambient cistern - laterally surrounds midbrian, connects quadrigeminal to interpeduncular
Cisterna magna
Suprasella
Pre-pontine etc
Temporal bone CT anatomy
.
Ivory vertebra
Blastic met Lymphoma Haemangioma Chordoma Pagets
Basilar tip thrombus
Also - artery of percheron - single trunk to bilateral medial thalami and rostral midbrain
Subependymoma
2/3 infratentorial grade 1, middle, older aged neurocytomas are in younger patients Ependymomas also in younger Small and don't enhance 50% become symptomatic
