Transcript Neck spaces
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) • Japanese iodine uptake x25 higher • 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. Child with neck mass • UM00421837 • 3.5 year old • Presented with mass in the neck Pt r2 ax avi pt r 2 cor Avi pt r 2 sag l Avi • Another child with neck mass Avi Expert DDX 5-12 Cystic neck masses in child DIA H&N 5-13 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(transspatial) • Synonyms = cystic hygroma/lymphatic malformation Region • Supra hyoid – submandibular and masticator spaces • Infrahyoid – posterior cervical space • Invaginates into normal structures with minimal mass effect/ multi or uni septated 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) 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 U/S • Confirm diagnosis • Classify type ( macrocysitic/microcytic and mixed) ( microcytic with cyst <1cm ) Biom Imag Interv J 2011;7(3): e 18 Take home point • Unilocular cervical lesion : thyroglossal cyst, branchial cleft cysts, thymic cyst • ( lymphangioma = multilocular) • Lymphangioma = trans spatial Treatment • Surgical • Bleomycin sclerotherapy Biom Imag Interv J 2011;7(3): e 18 Expert DDX H&N 5-14 Cystic neck masses in adult DIA H&N 5-16 Adult with neck mass • 53 yr • Right neck mass Avi Avi • 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 pt 2 with cbt Avi pt 2 w cbt cor Avi Patient with: • Neuropathy of left cranial nerve 7-12 • Tinnitus pt w tinnitis Glomus jugulare paraganglioma • Clinical: Pulsatile tinnitus with vascular retrotympanic mass • 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 • Permeative destructive bony changes on CT • Vertical part of the posterior wall of ICA often involved • DDX: • Jugular foramen schwanoma, meningioma, pseudolesion, metatases Patient 5 • Stridor, hoarseness, dyspnea • Smoking history • Right neck mass AVI Pt 5 avi Squamous cancer • Hypopharangeal SSCa • Prognosis better :pyriforme sinus>posterior wall> post cricoid • Moderately enhancing mass. • Central- Necrotic lymphnode metastases Suppurative lymph nodes Patient 6 • • • • Smoker Right neck mass FNA ? Primary tumour Du t thin avi • Styloidogenic jugular venous compression syndrome • Cause intracranial venous hypertension • Symptoms caused by an elongated styloid are rare but, when present, usually manifest as Eagle syndrome. • classic form of Eagle syndrome is caused by various degrees of impingement on cranial nerves V, VII, IX, or X by the styloid process. • second type of Eagle syndrome is related to carotid compression by an elongated styloid process In this fast growing world there is not a lot of open spaces….so I better stop typing before this space turns into something References • Diagnostic imaging anatomy: head and neck • Diagnostic imaging head and neck (Harnsberger) • Ulla Feldt-Rasmussen. Thyroid. May 2001, 11(5): 483-486. • Expert DDX