Diagnostics

Rowena Abante- Canlas MDSeptember 1, 2011

http://www.radiologyassistant.nl/images/4aedbcda28954nek-2.jpg

Differential Diagnoses

• Lipoma • Branchial cleft cyst • Haemangioma• Lymphoma• Abscess • Thyroglossal duct cyst• Metastatic disease

CT SCAN: NECK

SOFT TISSUE FILM OF THE NECK

CHEST XRAY

FNAB

Non-Contrast CT of the Neck: Axial

Non-Contrast CT of the Neck: Axial

(+) hypodense mass, with imperceptible wall,

(+) septations

Non-Contrast CT of the Neck: Axial

(+) central micro calcification

(+) large hypodense , transpatial mass, with imperceptible wall

(+) septations

Non-Contrast CT of the Neck: Coronal

(+) central micro calcification

(+) large hypodense , transpatial mass, with imperceptible wall

(+) septations

(+)tracheal deviation Left

Non-Contrast CT of the Neck: Coronal

Non-Contrast CT of the Neck: Sagittal

Non-Contrast CT of the Neck: Sagittal

Neck UTZ

Grossly enlarged septated complex mass with calcifications

Neck lateral

CXR

Normal Chest Findings

(+) soft tissue density over the lateral neck area, Right

FNAB

Right Lateral Neck Mass

Chronic Lymphadenitis, cervical lymph node FNAB

DIFFERENTIAL DIAGNOSES

Cystic Hygroma: CT Scan• NECT

– Low density, often poorly-circumscribed cystic neck mass

– Fluid levels may be seen in multiloculated lesions

• CECT:– No significant enhancement in cystic uni- or

multilocular neck mass– In absence of infection, wall is imperceptible & does

not enhance– If complex lesion with venous vascular components,

area of enhancing tissue or veins mat be seen

Cystic Hygroma: MRI

• T1W1– Primarily hypointense, but may be hyperintense if prior hemorrhage or high proteinaceous component– Fluid level often seen with multiple compartments

• T2W1– Best sequence to map lesion, as lymphangioma is hyperintense throughout– Trans-spatial, often poorly marginated

• T1 +C– Most often, no significant enhancement or subtle rim enhancement– If areas of enhancement seen, most likely a mixed rest with venous vascular or hemangiomatous component

Cystic Hygroma: UTZ• Primarily hypo or anechoic trans –

spatial mass

• Unilocular, or septated & multilocular

• Fluid-fluid levels suggest prior hemorrhage

• May be detected on prenatal UTZ

Cystic Hygroma: Histologic • (+) endotheium lined

cystic spaces, may have inflammatory cells

• (-) blood components inside

Thyroglossal Duct Cyst

Thyroglossal Duct Cyst

• It shows a lobulated cystic mass (arrows) in the neck at and below the hyoid bone in the midline and to the left of it, with portions of it behind the hyoid bone and portions embedded in the left strap muscle

Branchial Cleft Cyst

The lesion is situated between the submandibular gland and the anterior margin of the sternocleidomastoid muscle, which is the classic position of a second branchial cleft cyst.

The lesion shows edge enhancement post-Gadolinium. Notice that these lesions may contain small amounts of lymphoid tissue which is a possible explanation for the small area of enhancement inside the cyst wall (arrow).

Branchial Cleft Cyst

high signal intensity on STIR

Neck lipoma

SCM lipoma

AV MAlformation

Nasopharyngeal Cancer (Lymphoepithelioma) with Neck Metastasis

Lymphoma

Computed tomography of the head and neck shows the oropharyngeal process and a bulky cervical mass

Right cervical masse fixed, bulky, measured 13 × 10 cm in diameter

Lymphoma

NK/T-cell lymphoma, angiocentric infiltrate of small lymphocytes and atypical cells

Immunohistochemietry needed

Hemangioma

Hemangioma

scrofula

HISTOLOGY

Right Lateral Neck Mass FNAB:Chronic Lymphadenitis, cervical lymph node FNAB

Lateral neck mass, Rightt/c Cystic Hygroma

Doagnosis

On the left an axial T2-weighted image with fatsat and a coronal T1-weighted image of a 12-year old girl who presented with a soft swelling in the neck

Fat: The coronal T1-weighted image shows normal fat around the lesion.Nerves: Accessory nerve pathology is rare and we would expect a solitary solid lesion.Brachial plexus lesions are expected to be located in a more paraspinal location.Lymph nodes: Can be considered, but these are solid or partly solid. Embryological remnants: Remnants of the primitive lymphatic system like lymphangioma are most common in this age group and should be considered