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Saturday, April 21, 2007
Pitfall in head and neck imaging 2005
Easy node to miss
Facial, parotid, delphian (pre-laryngeal), suboccipital, Rouvier, supraclavicular, paratracheal
Wide FOV
Subtle focal defect
Cutaneous lesions
Pull shoulders using strap
Dont miss second-thrird-fourth primary ca.
For laryngeal ca., slice thickness and gantry titlting are important.
Time delay-several minutes later may be better
Puffed-cheek technique.
Retention cysts are very common.
Variant-accessory parotid, unusually prominent pterygoid venous plexus.
Sebaceous cyst mandibular tori.
L/N mimics-Posterior belly digastric muscle, levator scapulae, anterior scalene, Levator claviculae muscle which assist thoracic respiration (seen in 1-2% of the pop) almost always on the left side, behind the SCM or bilateral.
External ear fake-out (not written in the book)
Posterior condylar vein present unilaterally in 80%. Anastamotic vein between jug bulb and suboccipital venous plexus
Insect bite mimiching subcutanoues tumor.
Don't miss thrombosed IJV as necrotic lymph node.
Laryngocele mimics laryngeal tumor.
Vocal cord Teflon Injection
Montgomery thyroplasty
Denerved muscle enhances.
Nu-gauze packing and xeroform gauze bolster for maxillectomy defect.
Tru-soft obturator prosthesis for separating oral cavity from nasal cavity.-removable prosthesis.
Prosthesis may hide recurrence.
Sialocele after parotidectomy may mimic abscess or recurrence.
Compensatory hypertrophy of lavator scapulae accompanying spinal accessory denervation after neck dissection.
Some thyroid tissue may be left after "total" thyroidectomy.
Dental extraction may mimic destructive mandibular lesion.
UCLA to Ronald Reagan UCLA medical center.
Nonrecurrent laryngeal nerve 3-8% in the population Vast majority are on the right accompanying aberrent right subclavicular artery.
Judge it by posttracheal line. Watanabe A et al., Laryngoscope 2001.111.1756-
post-"traumatic" changes creates pseudomass.
Fibrous lingual septum in the midline is good for piercing.
IAC lipoma is "do nothing" lesion since symptom may be worsening after resection.
Normal bone marroe and neuritis may mimic small schwannoma. Do not operate stable small lesion of the VIII nerve.
Always obtain pre contrast T1WI.
PET/CT muscle, brown fat, benign parotid mass uptake may be false positive.
False negative cancer-well diff.
Facial, parotid, delphian (pre-laryngeal), suboccipital, Rouvier, supraclavicular, paratracheal
Wide FOV
Subtle focal defect
Cutaneous lesions
Pull shoulders using strap
Dont miss second-thrird-fourth primary ca.
For laryngeal ca., slice thickness and gantry titlting are important.
Time delay-several minutes later may be better
Puffed-cheek technique.
Retention cysts are very common.
Variant-accessory parotid, unusually prominent pterygoid venous plexus.
Sebaceous cyst mandibular tori.
L/N mimics-Posterior belly digastric muscle, levator scapulae, anterior scalene, Levator claviculae muscle which assist thoracic respiration (seen in 1-2% of the pop) almost always on the left side, behind the SCM or bilateral.
External ear fake-out (not written in the book)
Posterior condylar vein present unilaterally in 80%. Anastamotic vein between jug bulb and suboccipital venous plexus
Insect bite mimiching subcutanoues tumor.
Don't miss thrombosed IJV as necrotic lymph node.
Laryngocele mimics laryngeal tumor.
Vocal cord Teflon Injection
Montgomery thyroplasty
Denerved muscle enhances.
Nu-gauze packing and xeroform gauze bolster for maxillectomy defect.
Tru-soft obturator prosthesis for separating oral cavity from nasal cavity.-removable prosthesis.
Prosthesis may hide recurrence.
Sialocele after parotidectomy may mimic abscess or recurrence.
Compensatory hypertrophy of lavator scapulae accompanying spinal accessory denervation after neck dissection.
Some thyroid tissue may be left after "total" thyroidectomy.
Dental extraction may mimic destructive mandibular lesion.
UCLA to Ronald Reagan UCLA medical center.
Nonrecurrent laryngeal nerve 3-8% in the population Vast majority are on the right accompanying aberrent right subclavicular artery.
Judge it by posttracheal line. Watanabe A et al., Laryngoscope 2001.111.1756-
post-"traumatic" changes creates pseudomass.
Fibrous lingual septum in the midline is good for piercing.
IAC lipoma is "do nothing" lesion since symptom may be worsening after resection.
Normal bone marroe and neuritis may mimic small schwannoma. Do not operate stable small lesion of the VIII nerve.
Always obtain pre contrast T1WI.
PET/CT muscle, brown fat, benign parotid mass uptake may be false positive.
False negative cancer-well diff.
Posted by: Ds20040999 / 4:29 PM 
