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PEDIATRIC HEAD AND NECK MASSES: INTERVENTIONAL RADIOLOGICAL MANAGEMENT

PEDIATRIC HEAD AND NECK MASSES: INTERVENTIONAL RADIOLOGICAL MANAGEMENT . WILLIAM E. SHIELS II , D.O. Chairman Children’s Radiological Institute and Department of Radiology Children’s Hospital Columbus, Ohio. GOALS Provide imaging management update Diagnostic imaging approach

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PEDIATRIC HEAD AND NECK MASSES: INTERVENTIONAL RADIOLOGICAL MANAGEMENT

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  1. PEDIATRICHEAD AND NECKMASSES:INTERVENTIONALRADIOLOGICALMANAGEMENT

  2. WILLIAM E. SHIELS II , D.O.ChairmanChildren’s Radiological Institute andDepartment of RadiologyChildren’s HospitalColumbus, Ohio

  3. GOALS Provide imaging management update Diagnostic imaging approach Current state of the art Interventional Radiology Dx role Therapeutic options Pediatric Head and Neck

  4. FOCUS Congenital Inflammatory Neoplastic Benign Malignant PediatricHead and Neck

  5. Highly vascular tumor-benign Male predilection, 7-21 yrs Often present with epistaxis Nasopharynx, max/sphenoid sinuses CT +Contrast for Diagnosis Embolization prior to surgery Juvenile Nasal Angiofibroma

  6. Non-suppurative Sonography for diagnosis Suppurative- neck abscess US guided drainage US guided Bx, FNA Esp. cat scratch, mycobacterial Cervical Adenitis

  7. Not acute emergency May compromise airway Bacterial: Grp A. Strep; Staph CT best to diagnose, Sono to Tx Dissects laterally, up, down May dissect to mediastinum extrapleural Complicated Neck Abscess

  8. Branchial cleft remnants Second BC most common Cysts, sinuses, fistulae Same course to tonsillar fossae Unilocular cyst, +/- infection US or CT/MR for diagnosis Successful percutaneous ablation Branchial Cleft Cyst

  9. Venous and lymphatic malformations Slow flow MRI and US (pre-treatment) Arteriovenous malformations High flow, no ST mass MRI, angiography (pre-treatment) Vascular Malformations

  10. Lymphatic ductal malformation Posterior triangle most common Any space in neck, shoulder, Mediastinum, may invade airway Macrocystic (hygroma), microcystic Non-operative treatment +/- successful Lymphatic Malformation

  11. WHERE ARE WEWITHTREATMENT?

  12. Dual-DrugTime Limited ContactSclerotherapy of Cervicofacial Lymphatic Malformations

  13. DETERGENT (Sotradecol) Opens cellular channels Lipoprotein membrane ETHANOL Denatures proteins Cell destruction Inflammatory response MECHANISM

  14. LOCATIONS Neck Face (including parotid bed) Orbit (retrobulbar) - TYPES Macrocystic Microcystic LOCATIONS / TYPES

  15. US guided puncture 5 F Pigtail Complete aspiration

  16. Contrast cystogram and aspiration

  17. •Cystic mass-salivary glands Sublingual, submandibular, parotid Dilated ducts…to…..massive cysts Intraparenchymal cystic collections Huge “diving” ranulas in neck spaces RANULA

  18. Pseudocyst Sublingual, submandibular most common Treat infection Drain cystic collection: Mucous Sclerose cavity Regional ablation of salivary gland PLUNGING RANULA

  19. Plunging Ranula

  20. Simple Ranula

  21. •Cystic mass-salivary glands Sublingual, submandibular, parotid Dilated ducts…to…..large cysts Intraparenchymal cystic collections Usually rupture into mouth, decompress Tx: Percutaneous ablation first line therapy Surgical resection if ablation fails SIMPLE RANULA

  22. Cystic mass-head and neck Developmental origin Lines of embryonic suture closure Periorbital, anterior neck, nose, scalp Lined-keratinizing squamous epithelium Contain epithelium, sebum, debris Percutaneous ablation now an option EPIDERMOID/DERMOID

  23. 13 mo male H/o fall from Powerwheel Face first, left eye trauma Periorbital cellulitis T= 103oF CASE HX

  24. CONCLUSION Brief summary- common concerns Pathologic understanding Practical issues Imaging management rationale Therapeutic intervention options Pediatric Head and Neck Masses

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