1 / 66

Neck spaces: Cases

Neck spaces: Cases. Dr Frans Naude. Lesotho patient presented with neck swelling for the last 26 years . 1 avi. Key image 1. Iodine deficient regions Decrease thyroid hormone Increased TSH Goiter Risk of low iodine: increased breast cancer ( Japanese 6/100 000, USA 22/100 000)

kaipo
Download Presentation

Neck spaces: Cases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Neck spaces: Cases Dr Frans Naude

  2. Lesotho patient presented with neck swelling for the last 26 years

  3. 1 avi

  4. Key image 1

  5. Iodine deficient regions • Decrease thyroid hormone • Increased TSH • Goiter • Risk of low iodine: increased breast cancer ( Japanese 6/100 000, USA 22/100 000) • Japanese iodine uptake x25 higher

  6. Iodine deficiency is also associated with increased risk for thyroid carcinoma in animal models and humans. • Iodine replacement increase risk ratio from papillary to follicular cancer (Altern Med Rev 2008;13(2):116-127) Ulla Feldt-Rasmussen. Thyroid. May 2001, 11(5): 483-486.

  7. Child with neck mass • UM00421837 • 3.5 year old • Presented with mass in the neck

  8. avi Pt r2 ax

  9. pt r 2 cor Avi

  10. pt r 2 sag l Avi

  11. Another child with neck mass

  12. Avi

  13. Expert DDX 5-12 Cystic neck masses in child DIA H&N 5-13

  14. Lymphangioma • Def: Uni/Multiloculated ,non-enhancing cystic neck masses with imperceptible wall that insinuates between vessel and the normal neck structures • Contiguous neck space involvement(trans-spatial) • Synonyms = cystic hygroma/lymphatic malformation

  15. Region • Supra hyoid – submandibular and masticator spaces • Infrahyoid – posterior cervical space • Invaginates into normal structures with minimal mass effect/ multi or uniseptated

  16. CT Findings NECT: Low density, poorly circumscribed cystic neck mass • Fluid –Fluid lesions in multiloculated lesions CECT • No significant enhancement in mass or wall • (complex lesions, veins may cause enhancement)

  17. MRI • T1 w: Primarily hypointense , may be hyperintense due to hemorrhage or protein rich fluid. • Fluid –fluid levels often seen. • T2-w: hyperintense throughout ( best sequence to map lesion) • Trans-spatial extension/poorly marginated. • T1+C: most often no enhancement. If enhancement present ,most likely due to mixed vascular structures

  18. U/S • Confirm diagnosis • Classify type ( macrocysitic/microcytic and mixed) ( microcytic with cyst <1cm ) BiomImagInterv J 2011;7(3): e 18

  19. Take home point • Unilocular cervical lesion : thyroglossal cyst, branchial cleft cysts, thymic cyst • ( lymphangioma = multilocular) • Lymphangioma = trans spatial

  20. Treatment • Surgical • Bleomycinsclerotherapy BiomImagInterv J 2011;7(3): e 18

  21. Expert DDX H&N 5-14

  22. Cystic neck masses in adult DIA H&N 5-16

  23. Adult with neck mass • 53 yr • Right neck mass

  24. Avi

  25. Avi

  26. Carotid body tumor • Location : Mass in the center of the carotid bifurcation, splaying the ECA and ICA • Avid enhancing mass DI H&N III 8 :21

  27. pt 2 with cbt Avi

  28. pt 2 w cbtcor Avi

  29. Patient with: • Neuropathy of left cranial nerve 7-12 • Tinnitus

  30. pt w tinnitis

  31. Glomusjugulareparaganglioma • Clinical: Pulsatile tinnitus with vascular retrotympanicmass • Neuropathy : Cranial nerve 9-12 (sometimes 7&8) • Arises from margin of jugular foramen (neural crest cells surrounding the jugular foramen) • Projects supero-laterally into middle ear cavity • Permeativedestructive bony changes on CT • Vertical part of the posterior wall of ICA often involved

  32. DDX: • Jugular foramen schwanoma, meningioma, pseudolesion, metatases

  33. Patient 5 • Stridor, hoarseness, dyspnea • Smoking history • Right neck mass

More Related