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39 Cards in this Set

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Orbital Mass Lesions

Within or Involving the Globe
Retinoblastoma
(inheritance 1/20000 4 types i) non inheritible ii)inherited as an AD trait iii) association with partial deletion of Chr 13 iv) Bilateral retinoblastoma and pineal tumor-trilateral retinoblastoma

Melanoma
Detachment and choroidal effusion
Classify by site in relation to the muscle cone
Orbital Mass Lesions

Within the muscle cone (intraconal)
Optic Nerve Glioma
Optic Nerve Meningioma
Hemangioma (usually cavernous)
AVM
Inflammatory orbital pseudotumor (an enhancing soft tissue mass that may involve the muscle cone or optic nerve)
lymphoma and Mets
hematoma
Neurofibroma (rare)
Orbital Mass Lesions

Arising from the muscle cone
Inflammatory orbital pseudotumor
Dysthyroid opthalmopathy
rhabdomyosarcoma 50% < 7 yo 10% arise in the orbit *diffeerntiate between primary orbital location and parameningeal loaction as therapy differs
Orbital Mass Lesions

Outside the muscle cone (extraconal)
orbital cellulitis and abscess
lymphoma and mets
dermoid and teratoma (most common lateral aspect)
lymphangioma, lymphohemangioma
spread from lacrimal gland tumor
Orbital Mass Lesions

Arising from the Orbital wall
Mets lymphoma
Langerhans Cell Histiocytosis
Invasion by ethmoidal or maxillary antral tumors
ethmoidal mucocele
Spread of ethmoidal or antral infection
Enlarged Orbit
Neurofibromatosis
Congenital glaucoma (buphthalmos assymetrical enlargement)
Any space occupying lesion
Bare Orbit
Neurofibromatosis
Mets
menigioma
Enlarged Optic Foramen

Diameter > 7mm A diffence in 1mm diameter is abnormal when comparing to the opposite side.
Concentric Enlargement
optic nerve glioma
neurofibroma
extension of retinoblastoma'vascular
granuloma

Local Defect
Roof
adjacent neoplasm
raised intracranial pressure
Medial wall
adjacent neoplasm
sphenoid mucocele
Inferolateral wall (see superior orbital fissure)
Enlarged Superior Orbital Fissure
normal variant
neurofibromatosis
extension of itracranial lesion (meningioma, infraclinoid aneurysm, parasellar chordoma)
Mets to wing of Sphenoid
Extension of Orbital lesion (AVM, hemangioma, orbital memingioma, lymphoma)
Intraorbital calcification
In the Globe
cataract
retinoblastoma
old trauma / infection

Outside the Globe
phleboliths (AVN, hemangioma)
Orbital memningioma
Others (neurofibroma, intraorbital dermoid, adenocarcinoma of the lacrimal gland)
HyperOstosis in the Orbit
Meningioma
Sclerotic Mets
Fibrous Dysplasia
Paget's disease
Osteopetrosis
Chronic osteomyelitis
Lacrimal gland malignancy
LCH
Rx
Small or Absent Sinuses
Congenital
Congenital abscence
Cretinism
Down's
Kartageners

Outgrowth of Bony wall
Paget's Dx
Fibrous Dysplasia
Hemolytic Anemia
Post Caldwell-Luc operation
Opaque Maxillary Antrun
traumatic
fracture
overlying soft tissue swelling
Post-operative washout/Caldwel luc
Epistaxis
Barotrauma

Inflammatory / Infective
Infection
Allergy
Pyocele (infected mucocele)

Neoplastic
Ca
Lymphoma

Others
FD
Cysts (dentigerous and mucous retention cysts may be large enough to fill the antrum)
Wegener's
Mass in the Maxillary Antrum
Cysts
i) mucous retention cyst (result sinusitis more common and hard to differentiate from polyp)
ii) dentigerous cyst (extends upwards into the floor of the antrum. The involved tooth may be displaced into the antrum
Trauma (tear drop of prolapsed muscle)
Neoplasm
polyp complication of sinusitis
carcinoma (bone destruction local spread)
Wegener's (40-50 early mucosal thickening to a mass with bone destruction)
Cystic Lesions in the Jaw

Dental
Peridontal/radicular/periapical cysts(develop in carious tooth. well defined lucency with a thin sclerotoc margin. If large may erode the inner cortex of the mandible, displace adjacent teeth and/or extend into the maxillary antrum

Dentigerous Cyst (adjacent to the crown of an unerupted tooth (usually wisdomor canine0 If large may displace adjacent teeth and extend into the maxillary antra or nose. Mutiple cysts in Gorlin Syndrome)
Orbital Mass Lesions

Within or Involving the Globe
Retinoblastoma
(inheritance 1/20000 4 types i) non inheritible ii)inherited as an AD trait iii) association with partial deletion of Chr 13 iv) Bilateral retinoblastoma and pineal tumor-trilateral retinoblastoma

Melanoma
Detachment and choroidal effusion
Classify by site in relation to the muscle cone
Orbital Mass Lesions

Within the muscle cone (intraconal)
Optic Nerve Glioma
Optic Nerve Meningioma
Hemangioma (usually cavernous)
AVM
Inflammatory orbital pseudotumor (an enhancing soft tissue mass that may involve the muscle cone or optic nerve)
lymphoma and Mets
hematoma
Neurofibroma (rare)
Orbital Mass Lesions

Arising from the muscle cone
Inflammatory orbital pseudotumor
Dysthyroid opthalmopathy
rhabdomyosarcoma 50% < 7 yo 10% arise in the orbit *diffeerntiate between primary orbital location and parameningeal loaction as therapy differs
Orbital Mass Lesions

Outside the muscle cone (extraconal)
orbital cellulitis and abscess
lymphoma and mets
dermoid and teratoma (most common lateral aspect)
lymphangioma, lymphohemangioma
spread from lacrimal gland tumor
Orbital Mass Lesions

Arising from the Orbital wall
Mets lymphoma
Langerhans Cell Histiocytosis
Invasion by ethmoidal or maxillary antral tumors
ethmoidal mucocele
Spread of ethmoidal or antral infection
Enlarged Orbit
Neurofibromatosis
Congenital glaucoma (buphthalmos assymetrical enlargement)
Any space occupying lesion
Bare Orbit
Neurofibromatosis
Mets
menigioma
Enlarged Optic Foramen

Diameter > 7mm A diffence in 1mm diameter is abnormal when comparing to the opposite side.
Concentric Enlargement
optic nerve glioma
neurofibroma
extension of retinoblastoma'vascular
granuloma

Local Defect
Roof
adjacent neoplasm
raised intracranial pressure
Medial wall
adjacent neoplasm
sphenoid mucocele
Inferolateral wall (see superior orbital fissure)
Enlarged Superior Orbital Fissure
normal variant
neurofibromatosis
extension of itracranial lesion (meningioma, infraclinoid aneurysm, parasellar chordoma)
Mets to wing of Sphenoid
Extension of Orbital lesion (AVM, hemangioma, orbital memingioma, lymphoma)
Intraorbital calcification
In the Globe
cataract
retinoblastoma
old trauma / infection

Outside the Globe
phleboliths (AVN, hemangioma)
Orbital memningioma
Others (neurofibroma, intraorbital dermoid, adenocarcinoma of the lacrimal gland)
HyperOstosis in the Orbit
Meningioma
Sclerotic Mets
Fibrous Dysplasia
Paget's disease
Osteopetrosis
Chronic osteomyelitis
Lacrimal gland malignancy
LCH
Rx
Small or Absent Sinuses
Congenital
Congenital abscence
Cretinism
Down's
Kartageners

Outgrowth of Bony wall
Paget's Dx
Fibrous Dysplasia
Hemolytic Anemia
Post Caldwell-Luc operation
Opaque Maxillary Antrun
traumatic
fracture
overlying soft tissue swelling
Post-operative washout/Caldwel luc
Epistaxis
Barotrauma

Inflammatory / Infective
Infection
Allergy
Pyocele (infected mucocele)

Neoplastic
Ca
Lymphoma

Others
FD
Cysts (dentigerous and mucous retention cysts may be large enough to fill the antrum)
Wegener's
Mass in the Maxillary Antrum
Cysts
i) mucous retention cyst (result sinusitis more common and hard to differentiate from polyp)
ii) dentigerous cyst (extends upwards into the floor of the antrum. The involved tooth may be displaced into the antrum
Trauma (tear drop of prolapsed muscle)
Neoplasm
polyp complication of sinusitis
carcinoma (bone destruction local spread)
Wegener's (40-50 early mucosal thickening to a mass with bone destruction)
Cystic Lesions in the Jaw

Dental
Peridontal/radicular/periapical cysts(develop in carious tooth. well defined lucency with a thin sclerotoc margin. If large may erode the inner cortex of the mandible, displace adjacent teeth and/or extend into the maxillary antrum

Dentigerous Cyst (adjacent to the crown of an unerupted tooth (usually wisdomor canine0 If large may displace adjacent teeth and extend into the maxillary antra or nose. Mutiple cysts in Gorlin Syndrome)
Cystic Lesions in the Jaw

Non-Dental
Developmental/fissural cysts
i) nasopalantine cyst-usually between 4-6th decade. A small asymptomatic cyst near the anterior palantine papilla
ii)Globulomaxillary cyst between the lateral incisor and canine
iii)Nasolabial cyst-in the soft tissue between the nose and the upper lip
Hyperparathyroididm
Neoplasms
i)ameloblastoma 80% mandible 20% maxilla
ii)LGH
iii)ABC
iv) GCT
v)hemangioma
vi)mets
Fibrous Dysplasia
Bone cyst
Floating Teeth
Severe Peridontal disease
LCH
Hyperparthyroididm
Mets
Myeloma
Loss of Lamina Dura of the teeth
Generalized
Endocrine (osteoporosis, HPT, Cushings, Osteomalacia
Paget's Dx
Scleroderma

Localized
infection
neoplasm (leukemi, Myeloma LCH)
Mass in the Nasopharynx
Adenoid 1-7 years
Trauma (# of the upper cervical spine with hematoma)
Infection +/- speckeled gas in the mass
Neoplasms Benign
angiofibroma
antrochoanal polp

Neoplasms Malignant(Nasopharangeal ca, lymphoma, Rhabdomyosarcoma,plasmacytoma, extension of ca sphenoid/ethmoid and chordoma)
Encephalocele (midline defect in the base of the skull
Prevertebral Soft Tissue Mass on the Lateral Cervical X-Ray

Child
Trauma/hematoma
Abscess
Neoplasm (cystic hygroma, lymphoma, nasopharyngeal rhabdomyosarcoma, neuroblastoma
Mass on the Lateral Cervical X-Ray

Child
Trauma/hematoma
Abscess
Neoplasm (post cricoid ca, lymphoma, chordoma)
Pharangeale pouch (+/-air fluid level)
Retropharyngeal Goitre
Neck masses in Infants and Children
Soft
lipoma
hemangioma
cystic hygroma

Firm
cyst (thyroglossal, branchial cleft (lateral position) lingual, thymic)
abscess
hematoma
Inflammatory lymphadenopathy
Neoplastic lymphadenopathy
Neoplasia
Thyroid
Whole Body iodine Scan for Localizings Mets
Mets
Thyroid Bed
normal thyroid tissue (ectopic, retrosternal, sublingual)
Normal Uptake (GU tract, nasopharynx. saliavary gland stomach breast)
Photopenic 'Cold' Area in Radionuclide Thyroid Imaging
Loaclized
colloid cyst
adenoma
ca
multinodular goiter
local thyroiditis (may also be increased uptake)
Vascular
hemorrhage
artefacts
abscesses

Generalized Reduction in Uptake
Medication
Hypothyroidism
Ectopic Hormone Production
De Quervains Thyroiditis
Ectopic Thyroid