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Diagnostics
Rowena Abante- Canlas MDSeptember 1, 2011
Differential Diagnoses
• Lipoma • Branchial cleft cyst • Haemangioma• Lymphoma• Abscess • Thyroglossal duct cyst• Metastatic disease
CT SCAN: NECK
SOFT TISSUE FILM OF THE NECK
CHEST XRAY
FNAB
Non-Contrast CT of the Neck: Axial
Non-Contrast CT of the Neck: Axial
(+) hypodense mass, with imperceptible wall,
(+) septations
Non-Contrast CT of the Neck: Axial
(+) central micro calcification
(+) large hypodense , transpatial mass, with imperceptible wall
(+) septations
Non-Contrast CT of the Neck: Coronal
(+) central micro calcification
(+) large hypodense , transpatial mass, with imperceptible wall
(+) septations
(+)tracheal deviation Left
Non-Contrast CT of the Neck: Coronal
Non-Contrast CT of the Neck: Sagittal
Non-Contrast CT of the Neck: Sagittal
Neck UTZ
Grossly enlarged septated complex mass with calcifications
Neck lateral
CXR
Normal Chest Findings
(+) soft tissue density over the lateral neck area, Right
FNAB
Right Lateral Neck Mass
Chronic Lymphadenitis, cervical lymph node FNAB
DIFFERENTIAL DIAGNOSES
Cystic Hygroma: CT Scan• NECT
– Low density, often poorly-circumscribed cystic neck mass
– Fluid levels may be seen in multiloculated lesions
• CECT:– No significant enhancement in cystic uni- or
multilocular neck mass– In absence of infection, wall is imperceptible & does
not enhance– If complex lesion with venous vascular components,
area of enhancing tissue or veins mat be seen
Cystic Hygroma: MRI
• T1W1– Primarily hypointense, but may be hyperintense if prior hemorrhage or high proteinaceous component– Fluid level often seen with multiple compartments
• T2W1– Best sequence to map lesion, as lymphangioma is hyperintense throughout– Trans-spatial, often poorly marginated
• T1 +C– Most often, no significant enhancement or subtle rim enhancement– If areas of enhancement seen, most likely a mixed rest with venous vascular or hemangiomatous component
Cystic Hygroma: UTZ• Primarily hypo or anechoic trans –
spatial mass
• Unilocular, or septated & multilocular
• Fluid-fluid levels suggest prior hemorrhage
• May be detected on prenatal UTZ
Cystic Hygroma: Histologic • (+) endotheium lined
cystic spaces, may have inflammatory cells
• (-) blood components inside
Thyroglossal Duct Cyst
Thyroglossal Duct Cyst
• It shows a lobulated cystic mass (arrows) in the neck at and below the hyoid bone in the midline and to the left of it, with portions of it behind the hyoid bone and portions embedded in the left strap muscle
Branchial Cleft Cyst
The lesion is situated between the submandibular gland and the anterior margin of the sternocleidomastoid muscle, which is the classic position of a second branchial cleft cyst.
The lesion shows edge enhancement post-Gadolinium. Notice that these lesions may contain small amounts of lymphoid tissue which is a possible explanation for the small area of enhancement inside the cyst wall (arrow).
Branchial Cleft Cyst
high signal intensity on STIR
Neck lipoma
SCM lipoma
AV MAlformation
Nasopharyngeal Cancer (Lymphoepithelioma) with Neck Metastasis
Lymphoma
Computed tomography of the head and neck shows the oropharyngeal process and a bulky cervical mass
Right cervical masse fixed, bulky, measured 13 × 10 cm in diameter
Lymphoma
NK/T-cell lymphoma, angiocentric infiltrate of small lymphocytes and atypical cells
Immunohistochemietry needed
Hemangioma
Hemangioma
scrofula
HISTOLOGY
Right Lateral Neck Mass FNAB:Chronic Lymphadenitis, cervical lymph node FNAB
Lateral neck mass, Rightt/c Cystic Hygroma
Doagnosis
On the left an axial T2-weighted image with fatsat and a coronal T1-weighted image of a 12-year old girl who presented with a soft swelling in the neck
Fat: The coronal T1-weighted image shows normal fat around the lesion.Nerves: Accessory nerve pathology is rare and we would expect a solitary solid lesion.Brachial plexus lesions are expected to be located in a more paraspinal location.Lymph nodes: Can be considered, but these are solid or partly solid. Embryological remnants: Remnants of the primitive lymphatic system like lymphangioma are most common in this age group and should be considered