Head and Neck Imaging: A Teaching File

387 Pages·2011·182.588 MB·English

by  M.D. Mancuso, Anthony A., M.D. Bidari, Sharat

Head and Neck
I m a g i n g
A Teaching File
•
OND EDITION
Anthony A. Mancuso, MD
Professor and Chairman, Department of Radiology
Professor of Otolaryngology
University of Florida, College of Medicine
Gainesville, Florida
Sharat Bidari, MD
Clinical Assistant Professor
University of Florida, College of Medicine
Gainesville, Florida
With contributions from:
Bruno Termote, MD
Department of Radiology
Jessa Ziekenhuis
Hasselt, Belgium
Berit M. Verbist, MD, PhD
Leiden University Medical Center
Leiden, The Netherlands
Reordan DeJesus, MD
Neuroradiology Fellow
Duke University Hospital
Durham, North Carolina
I
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Library of Congress Cataloging-in-Publication Data
Mancuso, Anthony A.
Head and neck imaging : a teaching fle I Anthony A. Mancuso, Sharat Bidari ; with contributions from Bruno Termote ... [ et al.]. - 2nd ed.
p.;cm.
Rev. ed. of: Head and neck radiology I Anthony A. Mancuso. c2002.
Includes bibliographical references and index.
ISBN 978-1-60913-712-0 (alk. paper)
1. Head-Imaging-Atlases. 2. Neck-Imaging-Atlases. 3. Head-Imaging-Case studies. 4. Neck-Imaging-Case studies. I. Bidari,
Sharat. II. Termote, Bruno. ill. Mancuso, Anthony A. Head and neck radiology. IV. Title.
[DNLM: 1. Diagnostic Imaging-Atlases. 2. Diagnostic Imaging-Case Reports. 3. Head-Atlases. 4. Head-Case Reports. 5. Diagnosis,
Differential-Atlases. 6. Diagnosis, Differential-Case Reports. 7. Head and Neck Neoplasms-diagnosis-Atlases. 8. Head and Neck
Neoplasms-diagnosis-Case Reports. 9. Neck Injuries-diagnosis-Atlases. 10. Neck Injuries-diagnosis-Case Reports. 11. Stomatognathic
Diseases-diagnosis-Atlases. 12. Stomatognathic Diseases-diagnosis-Case Reports. WE 17]
RC936.M335 2012
617.5'107572--dc23
2011021911
Care has been taken to conf rm the accuracy of the information presented and to describe generally accepted practices. However, the
authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in
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10 9 8 7 6 54 3 2 1
To Bill Hanafee, for all ofh is wisdom, leadership, and kindness, and Paul Ward . .. who
together created a model ofw hat can be accomplished for interdisciplinary patient care
with a spirit ofm utual respect and everlastingfriendship.
AAM
Bruin fag at UCLA Pauley Pavilion at half mast in honor of
Bill's service-Summer 2010.
Bill in retirement in North San Diego County, likely getting ready
Bill in his off ce at UCLA, circa 1970s, preparing teaching to shoot a round of golf with his longtime friend and colleague
material Paul Ward
To our patients whose suffering is refe cted in the images on
these pages ... may we all learn from them and, with the utmost
compassion, improve daily our ability to f nd the best possible
outcomes for those affi cted with often devastating diseases.
AAM
BMV
To my Dad Subh as and late mother Lalita for teaching me the
values ofh ard work and perseverance, to my uncles Bhopal and
Laxman for their mentorsh ip throughout my medical school, to
my loving wife Divya for her constant support and my dear son
Dhruv who makes everything worthwhile.
SB
To my wife, thank you for your love and support. To my parents,
thank you for everything you did and still do for us. To Anthony
Mancuso, thank you for your excellent teaching and the
opportunity to participate in this project.
BMT
To Dr. Gilda Cardenosa for giving me many gifts and lessons,
the most treasured one: allowing genuine love and compassion
for our patients to be the guides ofo ur actions. Thank you for
inspiring me.
RD
I
'S FOREWORD
-------------------------
Teaching Files are one of the hallmarks of education in radiology . There has long been a need for a
comprehensive series of books, using the Teaching File format that would provide the kind of personal
consultation with the e xperts normally found only in the setting of a teaching hospital. Lippincott
Williams & Wilkins is proud to have created such a series; our goal is to provide residents, fellows and
practicing radiologists with a useful resource that answers this need.
Actual cases have been culled from extensive teaching fles in major medical centers. The discus
sions presented mimic those performed on a daily basis between residents and f acuity members in all
radiology departments.
The format of this series is designed so that each case can be studied as an unkno wn, if desired. A
consistent format is used to present each case. A brief clinical history is gi ven, followed by several
images. Relevant fndings, differential diagnosis, diagnosis, discussion of the case, questions for further
thought, reporting responsibilities and "what the treating physician needs to know" follow. Answers to
the questions conclude each case. In this manner the authors guide the reader through the interpretation
of each case, with a strong emphasis on critical thinking.
We hope that this series will become a v aluable and trusted teaching tool for radiologists at an y
stage of training or practice, and that it will also be a benef t to clinicians whose patients undergo these
imaging studies.
--The Publisher
ACKNOWLEDGMENTS
---------------------------------
Bill Hanafee and I had the good fortune of Ruby Richardson of J.B. Lippincott asking us to do our
frst book, Computed Tomography oft he Head and Neck, published in 1982. Almost 30 years later, the
f fth and by far the most comprehensive project the Lippincott Williams & Wilkins team has helped us
produce, Head and Neck Radiology by Mancuso and Hanafee, was released to the public in September
2010. This Teaching File book is a companion to that major work and is planned to coordinate with the
rich educational and clinical care content and emphasis of the "big book."
All of the production groups over the years have been consummate professionals dedicated to deliv
ering the best-quality resource to help care for patients with head and neck diseases. A special thanks
this time around to Ryan Shaw and Charley Mitchell for developing and guiding this project to its most
meaningful conclusion.
This work clearly would not have been possible without two other people. Kelly Paulling, my assis
tant, was truly extraordinary in helping with the manuscript and illustration preparation as well as count
less logistical issues. The second, Chris Sistrom, M.D., Ph.D., developed information technology (IT)
tools at the University ofFlorida College ofMedicine that allow for extraordinarily effcient collection
and transfer of images from our teaching f le repository to this and other educational resources. Also,
the online tool for computed tomography and magnetic resonance imaging protocols made available in
searchable form at www.xray. uf. edu and ref ected in Appendixes A and B of the text are a tribute to his
dedication and ingenuity. Those tools and the logistical setup of the IT workf ow through our computer
system that Chris created made the production process more eff cient than I could ever imagine.
Many thanks to these folks and the many others on the team, including my neuroradiology colleagues
who picked up my clinical slack from time to time, who made this almost 5-year project possible.
AAM
It has been an honor to w ork with my teacher and mentor Dr . Mancuso. I w ould like to sincerely
thank Dr. Ronald Quisling, Professor and Section chief, Dr. Jeffery A Bennett, Fellowship director and
Dr. Jimmy Johnson, Assistant Professor ofNeuroradiology Division at University of Florida for their
encouragement and support during this project.
SB
HOW TO USE THIS TEXT
The following 164 cases are examples drawn from a comprehensive core curriculum in head and neck
radiology. The crossover areas between traditional neuroradiology and ENT imaging such as neuro
ophthalmology, skull base pathology, and cranial nerve assessment are covered thoroughly. Diseases
that might be of primary interest to oral and maxillofacial surgeons are also presented.
The book chapters are organized by anatomic region, with each case in a chapter correlated to a spe
cif c chapter in Sections III through XVI of the core reference, Textbook ofH ead and Nee k Radiology
by Mancuso and Hanafee. That specif c chapter reference is displayed at the end of each case along
with a secondary r eference to the best corr elating chapter on the pathology or pathoph ysiology
related to the case as presented in Section II of the core text. This organizational framework allows
the reader or student to link the case to the more complete and fundamental anatomic, pathophysiologic,
reporting, and clinical conttxt knowledge presented in the core t~x.t. This will make study of the anatomy
and pathology within the scope of the "head and neck" discipline about as eff:ient and complete as pos
sible by way of this one-stop, comprehensive resource (assuming the core text is available).
Please realize that this book can be used as a guide in your daily practice of head and neck radiology
as well as a study guide for e xamination preparation. In fact, the book is intended to mo ve from the
older-style "teaching fle" type of resource emphasis on differential diagnosis as an endpoint of a case
to an endpoint that emphasizes critical thinking and synthesis of that thought process with the clinical
context. Hopefully, the reader's ability to synthesize imaging information, optimally structure report
content, and act on the information in a manner required by the acuity of the clinical situation will be
the main lessons learned in each case. "Making the diagnosis" remains an important b ut secondary
concern. The goal is to communicate and contribute, as an expert in this imaging subspecialty might,
to medical decision making.
To the ends just stated, the format in this edition has been changed to gi ve greater emphasis to the
discussion, and two other sections emphasizing clinical context have been added. Specif c recommen
dations with regard to report content that are acuity , problem, and study specif c have been added in
a section called "Reporting Responsibilities. " This edition also features another ne w section called
"What the Treating Physician Needs to Know"-the intent of this section being to make known to the
patient and treating medical pro vider the reasonable information yield of an imaging study in each
clinical scenario given the study's risks and cost.
Each section in the individual cases presents a portion of the planning/diagnostic/consultation/reporting
process which, when taken together, will help ensure accurate diagnosis and the best possible medical
decision making and, hopefully, outcome. The rationale for each section's content is as follows.
CLINICAL HISTORY It is essential to put summary imaging ftdings and disposition in a clinical contm:.t.
This discipline helps focus the remainder of the process. The information given is purposely typical of
that available in an imaging request form. It is the authors' sincere desire that with computer physician
order entry and linked electronic medical record information, such data, as part of a request for imaging
consultation, will become much more comprehensive and appropriate. For now, this is what most of us
are provided, so the cases are presented in that less than optimal mode.
FINDINGS The images are presented with a section composed of concise fgure legends describing the
important fndings. This section might be covered over if the cases are to be taken as ''unknowns."
DIFFERENTIAL DIAGNOSIS Based on the clinical presentation and imaging ftdings, a reasonable list of
differential diagnoses will be presented. In several cases, there will be no differential consideration.
DIAGNOSIS A summary statement of the basic disease process and, sometimes, pertinent associated
f ndings will help focus your understanding of the problem, as well as the implications for treatment,
and a need for further diagnostic evaluation.
DISCUSSION There may be some intended redundancy from case to case in this section. The repeti
tion will reinforce the need for logic and discipline in whate ver interpretative method you choose for
evaluating head and neck imaging studies.
The diagnostic process as presented in this section is, in most cases, anatomically driven at the out
set. The disease extent and morphology are then factored together with clinically relevant issues. The
reasons for reaching a particular diagnosis will be discussed, including ar guments against the other
differential possibilities when that is relevant. The differential diagnosis is, however, normally not the
endpoint. One must also consider the impact of the information on patient care and comment and report
appropriately for the acuity of the clinical situation on these issues in responding to the case material.
A search for expected complications of the diagnosed disease or a suggestion for further study is just
as relevant as producing an accurate diagnosis or differential diagnosis. This section, and the three that
follow, will encourage such processes.
Questions for Further Thought
Questions presented may e xpand on the theme of the case, emphasize clinical conte xt, or introduce
new material.
Reporting Responsibilities
This new section will f rst describe the acuity of a given clinical case and the urgency of communica
tion. The section will also summarize relevant information that would be benef cial to the clinician in
managing the case, sometimes in combination with the folio wing section, and that should appear in
the formal radiology report. Such information will generally include description of the pathology, its
extent and effects on adjacent structures, presence or absence of txpected complications, and any other
case-specif c details. It might also include recommendations for further evaluation.
What the Treating Physician Needs to Know
This new section will list, in b ulleted text, what information yield and direction the ordering pro vider
may reasonably expect in execution of an appropriately focused imaging protocol, the written report,
or as part of verbal consultation given the clinical context and imaging test at hand.
Answers
Learn More Box
The book chapters are organized by anatomic region, with each case in a chapter correlated to a spe
cif c chapter in Sections III through XVI of the core reference, Textbook ofH ead and Neck Radiology
by Mancuso and Hanafee. That specif c chapter reference is displayed at the end of each case in
a "Learn More Box" along with a secondary r eference to the best corr elating chapter on the
pathology or pathophysiology related to the case as presented in Section II of the core text.
CONTENTS
CHAPTER 1: The Eye, Orbit, and Visual Pathways, Including Cranial Nerves Ill, IV,
and VI 1
Case 1.1 Eye: Retinal, Choroidal, and Hyaloid Detachments 2
Case 1.2 Eye: Developmental Abnormalities and Acquired Alteration in the Size and Shape of the Eye 4
Case 1.3 Eye: Degenerative Conditions 6
Case 1.4 Tension Orbit and Its Acute Threat to Vision 8
Case 1.5 Eye: Acute and Chronic Infections 10
Case 1.6 Eye: Noninfectious Infammatory Diseases 12
Case 1.7 Eye: Trauma 14
Case 1.8 Eye: Intraocular Neoplastic Masses and Vascular Malformations 16
Case 1.9 Optic Nerve and Sheath: Developmental Abnormalities 18
Case 1.10 Optic Nerve and Sheath: Trauma 20
Case 1.11 Optic Nerve and Sheath: Acute and Chronic Infections and Noninfectious Infammatory Conditions 22
Case 1.12 Optic Nerve and Sheath: Benign and Malignant Tumors 24
Case 1.13 Intraconal Orbit: Orbital Pseudotumor and Acute and Chronic Infections and Noninfectious Inf ammatory Conditions 26
Case 1.14 Graves' Dysthyroid Ophthalmopathy (Orbitopathy) 28
Case 1.15 Intraconal Orbit: Vascular Malformations 30
Case 1.16 Intraconal Orbit: Tumors 32
Case 1.17 Bony Orbit and Extraconal Compartment: Developmental Lesions 34
Case 1.18 Extraconal Orbit: Orbital Pseudotumor, Noninfectious Inf ammatory Conditions, and Acute and Chronic Infections 36
Case 1.19 Orbit: Blunt Force, Fractures, and Penetrating Injuries 38
Case 1.20 Bony Orbit and Extraconal Compartment: Tumors 40
Case 1.21 Lacrimal Gland: Orbital Pseudotumor and Acute and Chronic Infections and Noninfectious Infammatory Conditions 42
Case 1.22 Lacrimal Gland: Benign and Malignant Tumors 44
Case 1.23 Nasolacrimal Apparatus: Developmental Conditions 46
Case 1.24 Nasolacrimal Apparatus: Acute and Chronic Infections and Noninfectious Infammatory Conditions 48
Case 1.25 Nasolacrimal Apparatus: Benign and Malignant Tumors 50
Case 1.26 Preseptal Compartment: Acute and Chronic Infections and Noninfectious Inf ammatory Conditions 52
Case 1.27 Preseptal Compartment: Benign and Malignant Tumors 54
Case 1.28 Cavernous Sinus: Noninfectious lnfammatory Conditions and Acute and Chronic Infections 56
Case 1.29 Cavernous Sinus: Benign Tumors and Developmental Masses 58
Case 1.30 Cavernous Sinus: Malignant Tumors 60
Case 1.31 Cavernous Sinus: Vascular Abnormalities 62
Case 1.32 Disorders of Conjugate Gaze: Cranial Nerve III, IV, and VI Neuropathies 64
Case 1.33 Posterior Visual Pathways: Chiasm to Visual Cortex 66
CHAPTER 2: Sinonasal and Craniofacial Region, Including Cranial Nerve V 69
Case 2.1 Developmental Craniofacial Anomalies: Syndromic, Clefts, Encephaloceles (Brain Heterotopias), and
Nasal Dermoids 70
Case2.2 Central Nervous System Leaks: Rhinorrhea and Otorrhea 72
Case2.3 Choanal Atresia and Nasal Pyriform Aperture Stenosis and Infantile Upper Airway Obstruction 74
Case 2.4 Facial and Sinonasal Vascular Malformations and Proliferative Hemangiomas 76
Case 2.5 Functional Endoscopic Sinus Surgery 78
Case2.6 Acute and Subacute Sinusitis 80
Case2.7 Chronic Sinusitis and Nasal Polyposis 84
Case2.8 Acute and Subacute Fungal Sinusitis 86
Case2.9 Chronic Noninfectious lnfammatory Conditions: Granulomatoses and Histiocytoses 88
Case 2.10 Maxillofacial Trauma: Blunt-force Fractures and Penetrating Injuries 90
Case 2.11 Sinuses, Nasal Cavity, and Central Skull Base: Solid Malignant Tumors 92
Case 2.12 Sinonasal Primary Bone-origin Tumors 94
Case2.13 Fibrous Dysplasia and Other Fibro-osseous Lesions of the Craniofacial Skeleton 96
Case 2.14 Sinonasal Systemic Malignancies 98
Case 2.15 Primary Bony and Metabolic Disorders of the Craniofacial Skeleton 100
Case 2.16 Disorders of Olfaction 104
Case 2.17 Trigeminal Neuralgia and Other Trigeminal Neuropathies 106
Case 2.18 Acute and Subacute Mandibular and Dental Infections and Noninfectious Infammatory Conditions 108
Case 2.19 Mandibular Trauma: Blunt-force Fractures and Penetrating Injuries 110
Case2.20 Mandible and Maxilla: Odontogenic Tumors and Cysts 112
Case 2.21 Mandible and Maxilla: Nonodontogenic Tumors and Cysts 114
Case2.22 Temporomandibular Joint: Introduction, General Principles, and Internal Derangements 116
Case2.23 Temporomandibular Joint: Inf ammatory, Degenerative, and Traumatic Conditions 118
Case2.24 Temporomandibular Joint Tumors 120