Download Neck spaces

Neck spaces: Cases
Dr Frans Naude
• Lesotho patient presented with neck swelling
for the last 26 years
1 avi
Key image 1
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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
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• 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
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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
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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