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Neck spaces: Cases

Neck spaces: Cases. Dr Frans Naude. Lesotho patient presented with neck swelling for the last 26 years . 1 avi. Key image 1. Iodine deficient regions Decrease thyroid hormone Increased TSH Goiter Risk of low iodine: increased breast cancer ( Japanese 6/100 000, USA 22/100 000)

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Neck spaces: Cases

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  1. Neck spaces: Cases Dr Frans Naude

  2. Lesotho patient presented with neck swelling for the last 26 years

  3. 1 avi

  4. Key image 1

  5. 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

  6. 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.

  7. Child with neck mass • UM00421837 • 3.5 year old • Presented with mass in the neck

  8. avi Pt r2 ax

  9. pt r 2 cor Avi

  10. pt r 2 sag l Avi

  11. Another child with neck mass

  12. Avi

  13. Expert DDX 5-12 Cystic neck masses in child DIA H&N 5-13

  14. 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(trans-spatial) • Synonyms = cystic hygroma/lymphatic malformation

  15. Region • Supra hyoid – submandibular and masticator spaces • Infrahyoid – posterior cervical space • Invaginates into normal structures with minimal mass effect/ multi or uniseptated

  16. 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)

  17. 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

  18. U/S • Confirm diagnosis • Classify type ( macrocysitic/microcytic and mixed) ( microcytic with cyst <1cm ) BiomImagInterv J 2011;7(3): e 18

  19. Take home point • Unilocular cervical lesion : thyroglossal cyst, branchial cleft cysts, thymic cyst • ( lymphangioma = multilocular) • Lymphangioma = trans spatial

  20. Treatment • Surgical • Bleomycinsclerotherapy BiomImagInterv J 2011;7(3): e 18

  21. Expert DDX H&N 5-14

  22. Cystic neck masses in adult DIA H&N 5-16

  23. Adult with neck mass • 53 yr • Right neck mass

  24. Avi

  25. Avi

  26. 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

  27. pt 2 with cbt Avi

  28. pt 2 w cbtcor Avi

  29. Patient with: • Neuropathy of left cranial nerve 7-12 • Tinnitus

  30. pt w tinnitis

  31. Glomusjugulareparaganglioma • Clinical: Pulsatile tinnitus with vascular retrotympanicmass • 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 • Permeativedestructive bony changes on CT • Vertical part of the posterior wall of ICA often involved

  32. DDX: • Jugular foramen schwanoma, meningioma, pseudolesion, metatases

  33. Patient 5 • Stridor, hoarseness, dyspnea • Smoking history • Right neck mass

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