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Introduction There have been rapid technological advances in medical imaging over the last several decades, generally providing faster, more detailed, & readily available assessments of patients. Clinical work-ups have increasingly incorporated advanced imaging during these years, though not always in an effective or judicious manner. In addition to concerns of financial cost, apprehensions have been increasingly raised about the downsides of several imaging modalities (including the…
Summary Thoughts: Masticator Space The 3 most frequently encountered abnormalities in the masticator space (MS) are infection, infection, and infection. Odontogenic infection should always cross the clinician's mind 1st when evaluating abnormalities in this space. When evaluating tumors of the MS, the presence of perineural CNV3 tumor spread is of critical importance because it is easily overlooked but can have a dramatic effect on treatment and…
KEY FACTS Terminology Non-Hodgkin lymphoma (NHL) of pharyngeal mucosal space (PMS) 3 subsites of Waldeyer lymphatic ring: Nasopharyngeal adenoids, palatine & lingual tonsils You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
KEY FACTS You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
KEY FACTS You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
KEY FACTS Terminology Synonym: Tonsillitis/tonsillopharyngitis Definition: Acute, nonsuppurative tonsillar inflammation You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
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KEY FACTS Terminology Definition: Benign developmental midline cyst in pharyngeal mucosal space (PMS) covered by mucosa anteriorly & bounded by longus muscles posteriorly You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
Summary Thoughts: Pharyngeal Mucosal Space Clinically, the upper aerodigestive track is often divided into the naso-, oro-, and hypopharyngeal subsites. Each of these subsites is unified, however, with mucosa that is subject to shared pathology. The pharyngeal mucosal space (PMS) is a key suprahyoid neck (SHN) space that represents the pharyngeal surfac e. The PMS has on its non-airway surface the middle layer of deep cervical…
KEY FACTS Terminology Parapharyngeal space benign mixed tumor (PPS-BMT): BMT is primarily in PPS, not extension of deep lobe parotid BMT into PPS Imaging Rounded, well-defined ovoid lesion within PPS fat Distinct from parotid deep lobe CECT findings Heterogeneous, moderately enhancing PPS mass MR findings Fat plane between deep lobe parotid & PPS-BMT T1 C+ MR: Uniform enhancement when small – Heterogeneous enhancement when large T2…
Summary Thoughts: Parapharyngeal Space The 4 key spaces of the suprahyoid neck (SHN) surround the parapharyngeal space (PPS), which is the fat-filled lateral SHN space. When large lesions of the SHN become hard to localize to a space of origin, the direction of the PPS displacement may be used in combination with the space where most of the tumor is located to make a determination as…
Imaging Approaches & Indications Neither CT nor MR is a perfect modality for imaging the extracranial H&N. MR is most useful in the suprahyoid neck (SHN) because it is less affected by oral cavity dental amalgam artifact. The SHN tissue is less affected by motion compared with the infrahyoid neck (IHN); therefore, the MR image quality is not degraded by movement seen in the IHN. Axial…
Introduction Rapid advancement of medical imaging in the last few decades has significantly enhanced the role of imaging in medicine. Imaging plays an integral role in the evaluation of many of the diseases confronted by the otolaryngologist. It is performed for diagnosis, staging of tumors, assessing efficacy of therapy, follow-up, and guidance for procedures. Imaging in the head and neck, like no other area of the…
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KEY FACTS Terminology Benign, often partially cystic sellar region tumor derived from Rathke pouch epithelium 2 types Adamantinomatous (cystic mass in childhood) Papillary (solid mass in older adults) Imaging General features Multilobulated, often large (> 5 cm) Occasionally giant, multicompartmental CT Cystic (90%), Ca++ (90%), enhancing (90%) MR: Signal varies with cyst contents Cysts variably hyperintense on T1WI and T2WI Solid portions enhance heterogeneously; cyst walls…
KEY FACTS Terminology Nonneoplastic cyst arising from remnants of embryonic Rathke cleft Benign sellar region endodermal cyst lined by ciliated, mucus-producing epithelium Imaging Nonenhancing, noncalcified, intrasellar &/or suprasellar cyst with intracystic nodule Completely intrasellar (40%), suprasellar extension (60%) Density/signal intensity varies with cyst content (serous vs. mucoid) Most symptomatic Rathke cleft cysts (RCCs): 5-15 mm in diameter Occasionally, RCCs can become very large Claw sign =…
KEY FACTS Terminology Acute clinical syndrome with headache, visual defects/ophthalmoplegia, altered mental status, variable endocrine deficiencies Caused by either hemorrhage or infarction of pituitary gland Preexisting pituitary macroadenoma common Imaging CT Sellar/suprasellar mass with patchy or confluent hyperdensity Peripheral enhancement, ± hemorrhage May be associated with subarachnoid hemorrhage MR Enlarged, hypointense (hemorrhagic), or hyperintense (nonhemorrhagic) pituitary on T2WI T2* (SWI/GRE) “blooming” (best sequence if blood products…
KEY FACTS Terminology Benign neoplasm of adenohypophysis Imaging Upward extension of macroadenoma = most common suprasellar mass in adults Best imaging technique MR with sagittal/coronal thin-section imaging through sella + T1 C+ with FS Sellar mass without separate identifiable pituitary gland = macroadenoma Mass is pituitary gland Usually isointense with gray matter Enhance strongly, often heterogeneously Cavernous sinus invasion difficult to determine Top Differential Diagnoses Pituitary…
KEY FACTS Terminology Microadenoma: ≤ 10 mm in diameter Imaging Intrasellar mass is typical location Rare: Ectopic origin outside pituitary fossa Best technique = dynamic contrast-enhanced thin-section T1-weighted MR Generally enhance more slowly than adjacent normal pituitary Beware: 10-30% can be seen only on dynamic contrast-enhanced scans Occasionally, adenoma may be cystic or hemorrhagic Intrapituitary “filling defect” may be benign nonneoplastic cyst, as well as incidental…