Head and Neck Imaging: Case Review Series

425 Pages·2010·25.221 MB·English

by  Nafi Aygun MD, David M. Yousem MD MBA

C A S E R E V I E W
Head and Neck Imaging
Series Editor
David M. Yousem, MD, MBA
Director of Neuroradiology and Professor of Radiology
Vice Chairman of Program Development
Russell H. Morgan Department of Radiology and Radiological Sciences
Johns Hopkins Medical Institution
Baltimore, Maryland
Other Volumes in the CASE REVIEW Series
Brain Imaging
Breast Imaging
Cardiac Imaging
Emergency Radiology
Gastrointestinal Imaging, Second Edition
General and Vascular Ultrasound, Second Edition
Genitourinary Imaging, Second Edition
Musculoskeletal Imaging, Second Edition
Nuclear Medicine, Second Edition
Obstetric and Gynecologic Ultrasound, Second Edition
Pediatric Imaging
Spine Imaging, Second Edition
Thoracic Imaging
Vascular and Interventional Imaging
Nafi Aygun, MD
Assistant Professor of Radiology
Johns Hopkins Hospital
Baltimore, Maryland
David M. Yousem, MD, MBA
Director of Neuroradiology and Professor of
Radiology
Vice Chairman of Program Development
Russell H. Morgan Department of Radiology and
Radiological Sciences
Johns Hopkins Medical Institution
Baltimore, Maryland
C A S E R E V I E W
Head and
Neck Imaging
THIRD EDITION
C A S E R E V I E W S E R I E S
1600 John F. Kennedy Boulevard
Suite 1800
Philadelphia, PA 19103-2899
HEAD AND NECK IMAGING: CASE REVIEW, THIRD EDITION ISBN: 978-0-323-07894-8
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To my wife, Meral, who is my
inspiration and refuge.
—NA
To all the residents, fellows, and
trainees preparing for exams and the
world to follow: Good luck. I hope
this is helpful on your journey.
To Kelly, the LOML: I love you always
and all ways.
To my kids and extended family:
Thanks for the love and support…
as always.
—DMY
SERIES FOREWORD
I have been very gratified by the popularity and positive feedback that the authors of the Case
Review Series have received upon the publication of the first and second edition of their
volumes. Reviews in journals and word-of-mouth comments have been uniformly favorable. The
authors have done an outstanding job in filling the niche of an affordable, easy-reading, case-
based learning tool that supplements the material in THE REQUISITES Series. I have been told
by residents, fellows, and practicing radiologists that the Case Review Series books are the ideal
means for studying for oral boards and subspecialty certification tests.
It was recognized that while some students learn best in a noninteractive study-book mode,
others need the anxiety or excitement of being quizzed or put on the hot seat. The selected
format for the Case Review Series (which consists of showing a limited number of images needed
to construct a differential diagnosis and then asking a few clinical and imaging questions) was
designed to simulate the boards experience. The only difference is that the Case Review Series
books provide the correct answer and immediate feedback. The limit and range of the reader’s
knowledge is tested through scaled cases; ranging from relatively easy to very hard. The Case
Review Series also offers a brief authors’ commentary, a link back to THE REQUISITES volume,
and an up-to-date reference in the provided literature.
Because of the popularity of the series, we have been rolling out the second and third edi-
tions of the Case Review Series volumes. The expectation is that the these editions will bring
the content up to the current knowledge limits of the field, introduce new modalities and new
techniques, and provide new and even more graphic examples of pathology. To adjust to the
upcoming change from an oral boards examination to a computer-based one, the Case Review
Series is also changing. Our intention is to move to an even more engaging live platform through
the use of the Internet. Thus, the questions are being reframed into multiple-choice format, the
links will be dynamic to online references, and feedback will be interactive with correct and
incorrect answers. Please see the website www.casereviewsonline.com to see how the Case
Review Series is evolving to best prepare trainees for the boards and practitioners for reading
specialty cases. Personally, I am very excited about the future. Join us.
It has been fun trying to marry the printed word with the ability to interact with the reader/
browser. I myself still prefer a hard copy book to cart with me from place to place with or
without Internet access, but I understand that the 21st century learner should have multiple
options at his or her disposal to best learn this difficult material.
Most of my readers know that some of my best ideas actually come from them. I am a frequent
traveler to auntminnie.com, where the feedback from residents, fellows, and radiology practi-
tioners has been quite helpful in designing the latest versions of the Case Review Series. Thanks
to all the commenters on the blog. You rule. Of course, I have also taken quite a few “hits” on
AM as trainees often dismiss head and neck radiology as not critical for the boards…which
is true. However, the radiologist who masters the head and neck becomes a valuable resource
to the academic team as well as the private practice group. It is a great feeling to be the “go
to” person in head and neck, since so few people are comfortable with this area. Therefore,
even though there may only be one, two, or three cases in the residency boards in head
and neck, it is still very fulfilling to learn this material. As one advances to subspecialty boards
where head and neck may be one third of the cases shown, this volume may play a greater
role in one’s preparation for the exam. However, even in practice, the head and neck imaging
volume may serve the purpose of enabling greater aptitude in a weak area in one’s imaging
armamentarium.
I am joined in this effort by the first author of the volume, Nafi Aygun. Nafi is a tremendous
resource, very knowledgeable in head and neck radiology. Like my former colleague Laurie
Loevner, who was my partner in head and neck imaging at HUP, Nafi has taught me a ton. He
is a great educator and has brought exciting new ideas to this volume. Thank you, Nafi.
I also want to thank Rebecca Gaertner and Tim Maxwell for their efforts in creating the online
version of the Case Review Series and for bringing it to fruition while still producing great
printed volumes. Good work.
My wife, Kelly, has endured the preparation of Neuroradiology: THE REQUISITES, third
edition, and Head and Neck Imaging: Case Review, third edition, in the first 2 years of our
marriage with patience and enthusiasm. I appreciate having a loving spiritual partner who ener-
gizes me in a way that keeps life and relationships fresh and exciting. Thank you for your loving
devotion. You are ever my muse. Fourth editions, here we come!
I still have that joy in teaching. I hope it never leaves. Enjoy. Send me feedback. We can
always make it better…together.
David M. Yousem, MD, MBA
PREFACE
Case-based learning in radiology is more popular than ever and for good reasons; it’s fun and
effective. It allows more critical analysis of imaging findings and their meaning with respect to
differential diagnosis. It requires integration of demographic information, clinical symptoms, and
findings into the radiologists’ decision-making process, making it a more stimulating experience
for the reader compared to passive reading. But case-based learning should be seen as comple-
mentary to traditional methods of learning, as it cannot be as comprehensive as textbooks.
Readers are encouraged to expand their knowledge of the topics presented here by reading
textbooks and articles. A suggested reading section is provided with the case discussion along
with a cross-reference to the third edition of Neuroradiology: THE REQUISITES. We paid atten-
tion to include recent review articles rather than original articles in the suggested reading section
to provide a more comprehensive coverage of the topic. We also tried, as much as possible, not
to alter the original clinical context so that the reader can better understand the link between
demographics, symptoms, and so forth, and radiologic diagnosis. Of course, at times the clinical
context itself may be misleading, but we accept that as a fact of our lives. There are 200 new
cases included in this third edition of the Head and Neck Imaging: Case Review. Some overlap
of topics covered is inevitable, but all the cases and images are different from the previous two
editions. Also different from the previous editions is the style of questions: Instead of the open-
ended questions on the previous editions, there are four multiple-choice questions for each case
in this edition. Whenever possible, we started with a differential diagnosis question and multiple
proposed answers with a “choose all that apply” format, which does not necessarily imply that
there should be more than one correct answer. All other questions have one best answer. There
are also some true/false questions which are still commonly used in radiology board examina-
tions. The rationale for the correct and incorrect answers is provided separately for each answer
in the electronic version of this book. In the print version, the explanation for the questions is
given in the comment section, although not always in the order in which the questions are
asked. Because of the limitations of the print version, there are no figure legends or arrows on
figures pointing out the abnormality provided, although these features are included in the elec-
tronic version.
I think the third edition of Head and Neck Imaging: Case Review will continue to please
the readers with its practical and to-the-point approach to head and neck radiology, and every-
one, from radiology residents to fellows to even seasoned radiologists, will find at least one
aspect of this book appealing.
I have been using a case-based teaching format in my conferences for residents and fellows
for the past several years. In these conferences, I have found the opportunity to develop certain
teaching techniques that I used in this book. I’d like to thank all the fellows and residents I
trained who unknowingly contributed to this work by allowing me to see better ways of pre-
senting information; without you, it would not have been possible.
Nafi Aygun, MD
Opening Round