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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) - PowerPoint PPT Presentation
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Neck spaces: CasesDr 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
avi
Pt r2 ax
Avi
pt r 2 cor
Avi
pt r 2 sag l
• Another child with neck mass
Avi
Cystic neck masses in child
DIA H&N 5-13
Expert DDX 5-12
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
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
Avi
pt 2 with cbt
Avi
pt 2 w cbt cor
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
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