radiology 2 Flashcards
are interventional measure often done in scotland for salivary obstruction
no
what are 3 interventional measures for salivary obstruction
- surgical removal of the stone
- removal of the gland
- dilate structures of the gland
why might surgical dilation of salivary ducts not be possible
extent of scar tissue from chronic infection
what must the salivary stone be to remove it
- mobile
- located in lumen/ main duct
- duct must be patent and wide to allow passage of the stone
where must the salivary stone be in the submandibular gland in order to remove it
within lumen or main duct distal to the posterior border of the mylohyoid
where does a salivary stone by in the parotid duct in order to remove it
distal to the hilum or anterior border of the gland
what must the duct be for balloon dilation
patent anterior to the stricture to allow passage of the equipment
what % of balloon dilation results in complete resolution
56
what 4 tests would be used to test for sjogrens
- blood test
- schirmer test
- sialometry
- labial gland biopsy
what 5 things are we looking for on an ultrasound for sjogrens
- atrophy of the gland
- heterogenous parenchymal pattern
- hypoechoic
- fatty infiltration
- changes suggesting MALT lymphoma
what do sjogrens syndrome pts have a higher risk of
developing lymphoma
what is the number 1 imaging modality for sjogrens
ultrasound
what is stage 1 on the diagnostic criteria for sjogrens
punctate
what is stage 2 on the diagnostic criteria for sjogrens
globular
what is stage 3 on the diagnostic criteria for sjogrens
cavitation
what is stage 4 on the diagnostic criteria for sjogrens
destructive
what other changes in the salivary glands mimic sjogrens
- radiotherapy
- SLE and sarcoidosis
what does radiotherapy do to salivary glands
causes atrophy
what is scintigraphy
injection of radioactive technetium 99 pertechnetate
what is the half life of the contrast used in scintography
6 hrs
what can you used in scintography to gain images
gamma camera
what does scintography of the salivary glands show us
how well the glands are working
what will there be in scintography of salivary glands if the gland is working well
uptake into the gland
what will there be on scintography of salivary glands if there is a tumour
reduced uptake
which tumour will not be seen on a scintography of salivary glands
warthins tumour
what is the first line imaging modality to rule out obstruction or neoplasia of salivary glands
ultrasound
when is a biopsy required of salivary gland
if neoplasia
what biopsy would be taken for neoplasia of salivary gland
FNA
core biopsy
give two examples og benign salivary tumours
- pleomorphic adenoma
- warthins tumour
what will a benign tumour of salivary gland be like on imaging
- well defined
- encapsulated
- peripheral vascularity
- no lymphadenopathy
name 3 malignant tumours of salivary gland
- mucoepidermoid carcinoma
- acinic cell carcinoma
- adenoid cystic carcinoma
what will a malignant salivary gland tumour look like on images
- irregular margins
- poorly defined
- increased/ tortuous internal vascularity
- lymphadenopathy
what may low grade malignancy imitate on images
benign
what is MRI useful for in salivary glands
surgical assessment of lesions that may not be seen on radiograph
which part of which salivary gland may not be seen on radiograph and need MRI
deep lobe of parotid
why should you do MRI before biopsy for salivary gland (parotid)
inflammatory appearances may appear on scan complicating diagnosis
when would you image minor salivary glands
when pathological or enlarged
what image would you take for a minor salivary gland if the indication is superficial
ultrasound
what image would you take for a minor salivary gland if the indication is deep
MRI
apart from a deep lesion, when else might a MRI be taken for a minor salivary gland
if bony involvement
what do minor salivary glands have a higher risk of than major glands
malignancy
where might you get bony involvement for minor salivary gland pathology
- retromolar pad
- hard palate
what are “B” symptoms of malignancy
- weight loss
- night sweats
what type of cancer do night sweats particularly relate to
lymphoma
why might malignancy cause issues in moving the tongue
if involvement of the hypoglossal nerve
what is the name for changes to a pts voice
dysphonia
when might a malignancy pt get loss of hearing
advanced disease - involvement of facial and vestibulocochlear nerves
what might malignant bone look like on radiograph
moth eaten
name the different things you have to describe about pathology on a radiograph
- site
- size
- shape
- margins
- internal structure
- effects
- tooth involvemnt
- no. of
name some radiographic signs of malignancy
- moth eaten bone
- floating teeth
- non-healing sockets
- unusual periodontal bone loss
- spiculated periosteal reaction
- ununsual uniform widening of PDL
- loss of lamina dura
- loss of bony outlines
- thinning of cortical margin
- spiking root resorption
what does a rapidly growing radiography lesion suggest
aggressive or malignant
which benign lesions grow at a rapid pace
- ameloblastoma
- central giant cell granuloma
- odontogenic maxomas
what type of margins would indicate a benign lesion radiographically
corticated defined margins
what might lack of cortication indicate
healing lesion
superimposed infection
fast growing lesion
what is a bad prognostic sign radiographically of a leison
moth eaten bone with no margins
why do benign lesions have corticated margins
because they are slow growing so the bone has time to react and expand with the lesion
what will benign lesions do to other anatomical structures
displace them due to slow growth
what will malignant lesions do to other anatomical structures
destroy them
will a malignant lesion cause displacement of the IAN
no
will a benign lesion cause displacement of the IAN
yes
what does generalised widening of the PDL indicate
malignancy
what does generalised loss of lamina dura indicate
malignancy
who is osteosarcoma commonly in
young adults - 30s
name 6 risk factors for osteosarcoma
- fibrous dysplasia
- retinoblastoma
- previous exposure to radiation
- previous primary bone cancer
- pagets disease
- chronic osteomyelitis
what % of osteosarcoma occur in the head and neck
10
what are the 4 most common symptoms of osteosarcoma
- persistent pain
- oedema
- paraesthesia
- B symptoms
what will be seen radiographically for late stage osteosarcoma
spiking periosteal reaction
what will osteosarcoma look like in its early stages, radiographically
- slightly moth eaten
- widened PDL
what is multiple myeloma
proliferation of plasma cells in bone marrow leading to overproduction of immunoglobulins
what is a solitary lesion of multiple myeloma called
plasmocytoma
what are multiple lesions of multiple myeloma called
multiple myeloma
who is most often affected by multiple myeloma
middle aged adults
what shape will multiple myeloma be radiographically
round and unilocular
what will the internal structure of multiple myeloma be
radiolucent
what will the margins of multiple myeloma be radiographically
well defined and not corticated
what can large lesions of multiple myeloma lead to
path fracture
if multiple myeloma is multi focal what can it affect
all of skeleton
which type of lymphoma is most often seen in the head and neck
B cell lymphoma
how can lymphoma initially persist
soft tissue lump
what is langerhans histocytosis
proliferation of langerhans cells and eosinophilic leucocytes
what are the 3 manifestations of langerhans histocytosis
- eosinophilic granulomas
- hand schuller christian disease
- letterer siwe disease
what is eosinophilic granulomas
solitary lesion, typically affects adolescents
what is hand schuller christian disease
multifocal eosinophilic granulomas
- chronic and widespread, begins in childhood and develops into adulthood
what is letterer siwe disease
widespread disease affecting children under 3 years old
what shape will langerhans histocytosis be
unilocular
what internal structure will langerhans histocytosis have
radiolucent
what margins will langerhans histocytosis have
smooth outline
what effects does langerhans histocytosis have
floating teeth
what 5 tissues cause bone metastasis
- lung
- prostate
- breast
- kidney
- thyroid
what will metastasis look like radiographically
- moth eaten
- radiolucent
what can breast and prostate metastasis be radiographically
sclerotic/ osteogenic
can we decipher between primary and secondary tumours radiographically
no - take good MH and clinical assessment
what can low grade malignancy mimic
benign lesion
name 3 differential diagnosis’ of malignancy on radiographs
- osteomyelitis
- osteoradionecrosis
- MRONJ
what is radiopaqueness in pathology due to
- increased thickness of bone
- osteosclerosis of bone
- abnormal tissues
- mineralisation of non-mineralised tissues
what is the main deviation between cysts and other pathologies
internal structure
what is another name for odontoma
dental hamartoma
what is an odontoma
benign tumour of dental tissues
what are odontomas made up of
enamel, dentine, cementum and pulp
what similarities to normal teeth do odontomas have
- detal follicle
- mature to a certain stage
do odontomas grow indefinitely
no, will mature
when are odontomas most common
2nd decade
what do odontomas correlate with
development of normal dentition
which gender is more likely to get odontomas
=
what are the two types of odontoma
compound
complex
what are compound odontomas
ordered dental structures
which type of odontoma are known as ‘mini teeth’
compound
where are compound odontomas most common
anterior maxilla
what are complex odontomas
disorganised mass of dental tissue
what appearance will complex odontomas have radiographically
clump of cotton appearance
where are complex odontomas more commonly found
posterior mandible
what internal structure do odontomas have
mixed radiopacities
what are the areas of radiodensities in odontomas
areas of enamel
what is the thin radiolucent margin around odontomas
follicle
what shape will odontomas have
well-defined
what clinical issues may odontomas have
- impaction of adjacent teeth
- root resorption
- dentigerous cyst
what is the management of odontomas
excision
what is the recurrence of odontomas
nil
what is idiopathic osteosclerosis
localised area of increased bone density
does idiopathic osteosclerosis have any association with inflammatory, neoplastic and dysplastic processes?
no
how are idiopathic osteosclerosis’s often diagnosed
incidental
what do idiopathic osteosclerosis’s have relevance to
ortho Tx
what is the incidence of idiopathic osteosclerosis
6%
when does idiopathic osteosclerosis present
adolescents
when do idiopathic osteosclerosis’s stop growing
adulthood
where do idiopathic osteosclerosis commonly occur
pre-molar/ molar region of mandible
