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CONGENITAL. HEAD & NECK. BRACHIAL CLEFT CYST. Description:.
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CONGENITAL HEAD & NECK
Description: • Brachial cleft cysts (BCC) are congenital anomalies and usually arise from eth second brachial arch during embryological development. During clinical presentation the cystic mass appears in the anteriolateral portion of the neck around the angle of the mandible.
Etiology: • Congenital anomaly
Epidemiology: • Bimodal age distribution. The first occurrence is at birth with the second peak seen in young adults. About 10% are bilateral in location.
Signs and Symptoms: • This cystic mass is usually painless.
Imaging Characteristics: • Shows well-defined round cystic mass posteriolateral to the submandibular gland. There is no contrast enhancement. CT • Shows cyst as low density. MRI • T1-weighted (T1W) image is hypointense. • T2-weighted image is hyperintense.
Treatment: • Complete surgical resection.
Prognosis: • Good.
Figure 1. Brachial Cleft Cyst Axial Contrast Enhanced CT shows a cystic lesion in the right neck of the child located anteromedial to the sternocleidomastoid muscle, posterolateral to the submandibular gland, and lateral to the carotid space. In a child, this is a classic location and appearance for a second type BCC. Other differential considerations would include suppurativelympadenitis or necrotic lymph node metastases (in an adult).
Figure 2. Brachial Cleft Cyst Axial CECT in a child shows a cystic lesion in the left posterior neck with overlying infiltration of the fat representing an inflamed second BCC.
TUMOR HEAD & NECK
TUMOR • Cavernous Hemangioma (Orbital) • Cholesteatoma (Acquired) • Glomus Tumor (Paraganglioma) • Parotid Gland Tumor (Benign Adenoma) • Thyroid Goiter
Description: • Cavernous hemangiomas of the orbit are the most common benign orbital tumors in adults.
Etiology: • These vascular malformations are composed of large dilated endothelium-lined vascular channels covered b a fibrous capsule.
Epidemiology: • These slow, progressive tumors usually occur in patients between the second and fourth decades of life and are slightly more common in females. These tumors are usually located intraconal, but extraconal cavernous hemangiomas are possible
Signs and Symptoms: • Patients present with painless proptosis (bulging eyes)
Imaging Characteristics: CT • Appear as well-defined, high-density, smooth-margined, homogeneous, rounded, ovoid (egg shaped), or lobulated mass with marked contrast enhancement. MRI • T1-weighted images demonstrate an isointense to hypointense well-circumscribed mass. • The tumor appears hyperintense to fat on T2-weighted images. • Postcontrast T1-weighted images show marked enhancement.
Treatment: • Surgical resection of these encapsulated benign tumors is the recommended treatment of choice.
Prognosis: • Surgical resection produces a high cure rate.
Figure 1. Cavernous Hemangioma Noncontrast CT showing smoothly marginated, high-density, round, contrast-enhancing intraconal mass of the left orbit displacing the left globe anteriorly.
Figure 2. Cavernous Hemangioma Sagittal T1-weighted postcontrast MR shows round, slightly hyperintense, retrobular mass displacing optic-nerve superiorly.
Description: • An acquired cholesteatoma consists of an accumulation of squamous epithelium in the middle ear.
Etiology: • Varies, depending on the specific type of cholesteatoma.
Epidemiology: • Unknown; however, a cholesteatoma is a relatively common reason for ear surgery.
Signs and Symptoms: • Most common sign is frequent recurrent painless discharge from the ear. Hearing loss may also be common.
Imaging Characteristics: • High-resolution CT (HRCT) is the preferred modality used to evaluate the mass-like lesion in the middle ear which erodes the ossicles and bone. CT • Thin section axial and coronal images useful in evaluating temporal bone. • Useful in planning surgery. • Can determine extent of cholesteatoma and related structures. • Acquired temporal bone cholesteatome characterized by a soft-tissue homogeneous mass with focal bone destruction (erosion).
MRI • Thin section axial and coronal images useful in evaluating temporal bone. • Useful in planning surgery. • Can determine extent of cholesteatoma and related structures. • Acquired temporal bone cholesteatoma (soft tissue mass) appears hypointense on T1-weighted images, no enhancement is seen following gadolinium. • Cholesteatoma is hyperintense on T2-weighted images .
Treatment: • Surgical intervention.
Prognosis: • Good.
Figure 1. Cholesteatoma Coronal NECT shows soft tissue density in the left middle ear with thickening of the tympanic membrane. The left scutum has a blunted appearance (compare to sharp tip of normal right side). findings are consistent with a cholesteatoma.
Figure 2. Cholesteatoma Axial NECT (A) of the temporal bones shows soft tissue in the left middle ear located lateral to the ossicles in the epitympanum (Prussak space). Mastoidectomy has previously been performed on the right. Coronal CT (B) in same patient shows soft tissue in left middle ear within Prussak space of the epitympanum with blunting of the scutum. Right mastoidectomy is present.
Description: • A glomus tumor or paraganglioma is a benign, slow growing, hypervascular lesion. They are named according to their anatomic location such as glomus vagale (most common) when in the carotic space above the carotid bifurcation. Others, such as, glomus jugulare are associated with the jugular foramen and glomus tympanicum when associated with the middle ear.
Etiology: • This is a benign tumor arising from the neural crest paraganglion cells of the extracranial head and neck.
These lesions may be multiple in 5% of the patients and almost 30% of the patients have a familial history of the disease. Epidemiology: • These lesions may be multiple in 5% of the patients and almost 30% of the patients have a familial history of the disease.
Signs and Symptoms: • Depends on the location of the tumor.
Imaging Characteristics: CT • Contrast-enhanced study demonstrates an enhancing, well-circumscribed, soft tissue mass. MRI • T1-weighted images show mixed signal intensity mass with multiple signal (flow) voids. • Paragangliomas produce a high signal on T2-weighted images. • Postcontrast T1-weighted images of the tumor are hyperintense with signal (flow) voids giving it a salt-and-pepper appearance.
Treatment: • May require surgery, radiation therapy, or both.
Prognosis: • Good, this a benign tumor.
Figure 1. Glomus Tumor (GlomusVagala) T1-weighted left parasagittal image shows an intermediate signal mass (asterisk) of the upper neck at the carotid bifurcation. The external carotid artery (arrow) is displaced anteriorly.
Figure 2. Glomus Tumor (GlomusVagala) Postcontrast T1-weighted axial image shows a large markedly enhancing mass of the upper neck splaying the internal and external (arrows) carotids above the common carotid artery bifurcation.
Figure 3. Glomus Tumor (GlomusTympanicum) Axial CT shows soft tissue in the right middle ear overlying the cochlear promontory. Permeative bone loss is seen in the mastoid bone adjacent to the posterior fossa on the right.
Figure 4. Glomus Tumor (GlomusJugulotympanicum) Axial fat-sat (FS) T1W with gadolinium shows enhancing mass in right mastoid region and jugular fossa. Serpentine flow voids represent vessels.
Figure 5. Glomus Tumor (GlomusJugulotympanicum) Coronal FST1W with gadolinium shows enhancing mass extending from right middle ear into jugular fossa representing a glomus jugulotympanicum tumor (paraganglioma).
Figure 6. Glomus Tumor (GlomusTympanicum) Clinical otoscopic images show a blue vascular mass located behing the eardrum. This corresponds to the mass even on the cochlear promontory (figure 3).
Description: • The salivary glands can be divided into major and minor types. The major salivary glands include the parotid, submandibular, and sublingual glands. The parotid gland is the largest salivary gland and forms the majority of salivary neoplasms. The minor salivary glands are comprised of hundreds of smaller glands distributed throughout the mucosa and aerodigestive tract.
