Transcript pediatric sonographic imaging and intervention

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
Pediatric Head and Neck
GOALS
• Provide imaging management update
• Diagnostic imaging approach
• Current state of the art
• Interventional Radiology Dx role
• Therapeutic options
Pediatric Head and Neck
FOCUS
• Congenital
• Inflammatory
• Neoplastic
– Benign
– Malignant
Juvenile Nasal Angiofibroma
•Highly vascular tumor-benign
•Male predilection, 7-21 yrs
•Often present with epistaxis
•Nasopharynx, max/sphenoid
sinuses
•CT +Contrast for Diagnosis
Cervical Adenitis
• Non-suppurative
– Sonography for diagnosis
• Suppurative- neck abscess
– US guided drainage
• US guided Bx, FNA
– Esp. cat scratch, mycobacterial
Complicated Neck Abscess
• 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
Branchial Cleft Cyst
• 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
Vascular Malformations
• Venous and lymphatic malformations
– Slow flow
– MRI and US (pre-treatment)
• Arteriovenous malformations
– High flow, no ST mass
– MRI, angiography (pre-treatment)
Lymphatic Malformation
• Lymphatic ductal malformation
• Posterior triangle most common
– Any space in neck, shoulder,
– Mediastinum, may invade airway
• Macrocystic (hygroma), microcystic
• Non-operative treatment +/- successful
WHERE ARE WE
WITH
TREATMENT?
Dual-Drug
Time Limited Contact
Sclerotherapy
of
Cervicofacial
Lymphatic Malformations
MECHANISM
• DETERGENT (Sotradecol)
– Opens cellular channels
– Lipoprotein membrane
• ETHANOL
– Denatures proteins
– Cell destruction
– Inflammatory response
LOCATIONS / TYPES
• LOCATIONS
• Neck
• Face (including parotid bed)
• Orbit (retrobulbar) • TYPES
• Macrocystic
• Microcystic
US guided puncture
5 F Pigtail
Complete aspiration
Contrast cystogram and aspiration
RANULA
•Cystic mass-salivary glands
•Sublingual, submandibular, parotid
•Dilated ducts…to…..massive cysts
•Intraparenchymal cystic collections
•Huge “diving” ranulas in neck spaces
PLUNGING RANULA
•Pseudocyst
•Sublingual, submandibular most common
•Treat infection
•Drain cystic collection: Mucous
•Sclerose cavity
•Regional ablation of salivary gland
Plunging
Ranula
Simple
Ranula
SIMPLE RANULA
•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
EPIDERMOID/DERMOID
•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
CASE HX
• 13 mo male
• H/o fall from Powerwheel
• Face first, left eye trauma
• Periorbital cellulitis
• T= 103oF
Pediatric Head and Neck Masses
CONCLUSION
•Brief summary- common concerns
•Pathologic understanding
•Practical issues
•Imaging management rationale
•Therapeutic intervention options