Top 3 Differentials - Head And Neck

Front 1

Enhancing orbital mass

Back 1

M2L2 + HG

Hemangioma (+enh, Ca)
Lymphangioma (cystic, hemg, F/F)
Meningioma (+enh, -+Ca, no IC extention, OG do)
Mets (Adults-Br/L/GI, Kids-NB, Wilms, Ewing)
Lymphoma (painless, B/L, NH)

Front 2

Orbital rim fracture

Back 2

Orbital wall blowout fracture (EOM entrapment?)

Tripod fracture [FIZL =FrontoZyg suture, IO rim, Zygomatic Arch, Lat Maxillary wall)

Le Fort fracture

Front 3

Cavernous sinus mass/enhancement

Back 3

MCATs

M-MGMeningioma|Mets (Perineural Spread)
C-CCF (early v. drain via SOV)

A-Aneurysm
T-Tolosa-Hunt|Trigeminal Schwannoma
s-Sarcoidosis

Front 4

Aggressive sinus disease with bony destruction

Back 4

Invasive fungal sinusitis (IC, Mucur, Aspergil)

Wegener

Sinonasal carcinoma (SCC)

Lymphoma (HL, Wyldeyer's)

Cocaine nose (ischemic necrosis)

Front 5

Unilateral parotid mass

Back 5

Pleomorphic adenoma[MA, H^T2]
Warthin tumor [MA men, cyst/solid c/o, +-B/L]
Parotid carcinoma [ME, ACC]

Lymphadenopathy [inx, inf, CA - Lph, met H/N, mets sk (SCC and melonoma]

Branchial cleft cyst

Front 6

Bilateral parotid masses

Back 6

Lymphoepithelial lesions[AIDS, Lph infiltration]
Sjogren syndrome [dry eyes and mouth]
Warthin tumors [MA men, can be B/L]
Lymphadenopathy [Lph and mets]
Sarcoidosis [^ACE levels, +Ga67]

Front 7

Orbital muscle enlargement

Back 7

LIMP+Graves

Lph

Infectious myositis [subperiosteal abscess]

Mets

Pseudotomor-Orbital pseudotumor -U/L, mt jnx, LR

Thyroid-associated orbitopathy[TAO]=Grave's, spares mt jnx, IM SLOw, Tx: GCS

Front 8

Pharyngeal mucosal mass

Back 8

Squamous cell carcinoma(fossa of Rosenmuller)
Lymphoma (NH)
Infection/abcess
Minor salivary gland tumor
Thornwaldt cyst (cystic and midline)

Front 9

Masticator space mass

Back 9

MS contains 1.muscles --> RSA, 2.mandible (bone&teeth)-->inx/abscess (MC), OSA 3.CN V3--> NS tumors (NF, SW)

Infection/abcess
Sarcoma
Venolymphatic malformation
Nerve sheath tumor

Front 10

Carotid space mass

Back 10

CS contents: 1.carotid a. (body)-->A 2.Jug V.--> vasc abnlty 3.CN9-12-->B 4.LN<--mets&Lph

A. Paraganglioma[salt&paper, avid enh, i.carotid body-->@bifurcation, splays ICA&ECA, ii.glomus vegale-->ICA d/l anterior]

NST[Nerve sheath tumor]-NF&SW
Vascular abnormality
LAD

Front 11

Retropharyngeal mass

Back 11

Infection/abcess

Nodal mets-SCC (from pharyngeal mucosa)

Lph-NH

Venolymphatic[VL] malformation-a.Cav. HG[wc, vasc. chanels, +phlebs, ^enh on CT/MRI] b. LphG[ML cystic x facial planes, _dense CT/follow fluid on MRI]

Tortuous internal carotid artery

Front 12

Clival mass

Back 12

Clivus Mass (C2 M2)

Chordoma-MC @ends, skull&sacrum, _T1/^T2

Chondrosarcoma[CSA]

Mets-Pb KTL _T1/^T2

Invasive pituatary Macroadenoma[>10mm, hormonally inactive, mass effect, micro<10mm, horm active]

Plasmacytoma

Front 13

Vascular injury to the neck

Back 13

Dissection-Cx-PSA, TE, Occlusion

PSA-DUS-->"to&fro"

AVF

Thrombosis

Front 14

Globe lesion in a child

Back 14

RB-MC globe tumor in kids, <5yr as leukocoria, 75% U/L, 25% B/L, Tri/L--> B/L + PG, Quad/L--> B/L+PG+SS. NL sz globe + Ca

PHPV-micropthalmia+^dense vitreus, NO Ca

micropthalmia in full term infant

Coats disease-y. m. kids, subret. exudates & ret. detachment. NL sz globe+NO Ca

Retinopathy of prematurity(ROP)-B/L micropth + hx of prematurity

Toxocariasis-NL globe sz, NO Ca, hx of contact w/ cats and dogs

Front 15

Optic nerve enlargement and enhancement

Back 15

Optic nerve glioma
Optic neuritis
Optic nerve sheath MG (tram track)

Lph/Lk

Sarcoidosis

Front 16

Pachymeningeal enhancement

Back 16

IC hypotension*
(CA)Mets-Pb L, Lph/Lk
(Inx)Pachymeningitis-inx (B/V/F)
(blood)SDH

Sarcoidosis

Lepto-CA, Inx, Blood (SAH), NeuroSarcoid, + SA Infaction*

Front 17

Middle ear mass

Back 17

Acquired cholesteatoma [epidermoid cyst, "skin in wrong place," erosion of scutum and malleus]

Facial nerve SW [labarinthine segment]

Glomus tympanicum [along coch promotory, salt&paper]

Normal variant vasculature[aberant ICA, dehiscent jugular]

Cholesteral granuloma[petrous apex

Front 18

Temporal bone trauma with mastoid fluid

Back 18

Longitudinal[MC subtype-75%, ossicular D/L --> ice cream falling of cone, CHL]

Transverse[SHL&tenitus, >>> involv't of Facial N, than with Longitudinal fx]

Mixed temporal bone fracture [look for vasc injuries-jugular canal and petrous ICA]

Front 19

Inner ear congenital malformation

Back 19

Large vestibular aqueduct syndrome(LVAS)[>1.5 cm]

Cystic cochleovestibular anomaly[figure 8]

Cystic common cavity

Cochlear aplasia
Labyrinthine ossificans

Front 20

Floor of the mouth mass

Back 20

SCC[+tob, mylohoid mm devide floor of mouth into subling and submand compartments]

Infection/abcess [Ludwig's Angina]

Ranula [SR vs DR]

Congenital thyroid lesion[lingual thyroid & TGDC]

VLM[cap. HG vs LG]

Dermoid/epidermoid cyst [Restricted DWI]

Front 21

Aggresive nasal mass in an adolescent

Back 21

Juvenile angiofibroma
Enthesioneuroblastoma
Hemangioma
Rhabdomyosarcoma
Inverted papilloma
Polyps

Front 22

Cystic neck mass

Back 22

Congenital cyst[1.TGDC-85% midline, 75% IFN 2.BCC-4 types. Type 2 MC.

Abscess

Cystic LN-2/2 inx & mets (SCC H/N & Papillary TC

Lymphatic malform. (LM)-Cyst. Hygroma & LG

Cystic NST-SW in carotid space

Front 23

Jugular foramen mass

Back 23

MG-MC EAx Tumor, CT:iso-^dense, hyperostosis, MRI-iso to GM on T1&T2, diff enh, dural tail

SC-uncommon, arise from CN9, Sx u mass effect, MRI-->_T1/^T2, marked enh, erosive bony

Paraganglioma-Glomus Jugulare (GJ)-^vasc. lesion, ass w/ permeative bone destruction, MRI--> salt&paper, fv

Mets-Pb L MC skull base mets, multiple

Dehiscent jugular bulb-High riding vs dehiscent

Front 24

Petrous apex lesion

Back 24

Cholesterol granuloma-2/2 chr. inf change, MC 1 lesion petrous apex, CT-_dense, expands, erodes, MRI-^T1/T2 due to hmge, NO enh

Mucocele-CT:_dense, expansile, MRI _T1/^T2, T1 u mucus, < CG. NO enh

Congenital cholesteatoma-CT:_dense, expansile, MRI-^T2 (cystic c/o), T1 hypo-heper, < CG. +RD, +/- thin periph enh.

Apical petrositis

Neoplasm (Pb L, Lph, CSA--> T2 bright)

Front 25

Leptomeningeal enhancement

Back 25

SA infarction

(CA)Leptomeningeal carcinomatosis
(Inx)Meningitis

(Blood)SAH
Neurosarcoidosis

Front 26

Le Fort

Back 26

I-NS, max

II-NB, max, IO wall, MO wall, maxillary s.

III-NB, max, IO, MO, LO walls, ZF suture

all include fx pteregoid

Front 27

Anterior and Posterior Neck Spaces

Back 27

Ant(4)-MS, PS, CS, PPS[ParaPharyngeal, triangle of fat on T1]

Post(3)-PVS[PerIvertebral], RPS, PCS

Front 28

Globe Lesion in Child

Back 28

Front 29

Brachial Cleft Cyst (BCC)

4Types:

a. Type 1 - 2nd MC -from EAC-MA

b. Type 2 - MC @angle of Mandible (MA)

c. Type 3 - sinuses, posterior

d. Type 4 - sinuses, larynx & TG

Back 29