Manual of Head and Neck Imaging. Prashant Raghavan Sugoto Mukherjee Mark Jameson Max Wintermark

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2 Manual of Head and Neck Imaging Prashant Raghavan Sugoto Mukherjee Mark Jameson Max Wintermark 123

3 Manual of Head and Neck Imaging

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5 Prashant Raghavan Sugoto Mukherjee Mark J. Jameson Max Wintermark Manual of Head and Neck Imaging

6 Prashant Raghavan, MD Division of Neuroradiology Department of Diagnostic Radiology and Nuclear Medicine University of Maryland School of Medicine Baltimore, MD USA Sugoto Mukherjee, MD Division of Neuroradiology Department of Radiology and Medical Imaging University of Virginia Health System Charlottesville, VA USA Mark J. Jameson, MD, PhD, FACS Division of Head and Neck Surgical Oncology Department of Otolaryngology Head and Neck Surgery University of Virginia Health System Charlottesville, VA USA Max Wintermark, MD Department of Radiology and Medical Imaging University of Virginia Health System Charlottesville, VA USA ISBN ISBN (ebook) DOI / Springer Heidelberg New York Dordrecht London Library of Congress Control Number: Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

7 Foreword Despite the technical challenges and expertise necessary to be a skillful head and neck radiologist, most in the discipline of neuroradiology have historically focused upon the central nervous system and not the head and neck, an anatomic region whose composition is both fascinating and complicated. Additionally, as the specialty of otolaryngology head and neck surgery continues to mature, the requirement for both radiologist and surgeon to be adept at recognizing the best scan to order as well as interpreting them becomes increasingly important. The authors of this book represent expertise not only in this radiologic subspecialty but also in all aspects of otolaryngology head and neck surgery, sharing with the reader their knowledge in conjunction with high quality, up-to-date radiologic examples of the pathology to create a guide for both the inexperienced as well as the skillful practitioner in both fields as well as their trainees. Paul A. Levine, MD, FACS Department of Otolaryngology Head and Neck Surgery University of Virginia Health System Charlottesville, VA, USA v

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9 Preface There are several outstanding reference books on the incredibly complex topic that is head and neck imaging. Of these, the most authoritative and popular are perhaps Head and Neck Imaging by Drs. Som and Curtin and Diagnostic Imaging: Head and Neck by Drs. Harnsberger, Hudgins, Wiggins and Davidson. These are considered essential reading for any serious student of the subject, and we recommend them too. Ours is a concise book, written with the intention of serving as an introductory text. It is written with the hope that residents and fellows, both in radiology and otolaryngology, can easily consume it, perhaps during the course of a rotation. The material contained in it is the basics of what one must know about cross-sectional head and neck imaging. Practical anatomical concepts and the imaging findings in the more common disease entities are emphasized. Also included, in each chapter, is a brief section written by a surgeon to provide a clinical perspective. Each chapter also has suggestions for further reading. As with any book of this size, we run the risk of excluding certain entities. We would like to thank our teachers those who we have had the fortune to know personally and also those that have influenced us through their books and lectures. Of the former, we are most grateful to Dr. C. Douglas Phillips, MD, FACR, Professor of Radiology and Director of Head and Neck Imaging at the Weill Cornell Medical Center, New York-Presbyterian Hospital, and Dr. Paul Levine MD FACS, Robert W. Cantrell Professor and Chairman, Department of Otolaryngology Head and Neck Surgery, University of Virginia Health System. Behind every image in this book is a patient to every one of them, we are grateful. We are also thankful to Philip J. Cohen for his assistance with the artwork. To our families, who have stood by us throughout this sometimes taxing, but always rewarding, endeavor, we owe everything. Baltimore, MD Charlottesville, VA Charlottesville, VA Charlottesville, VA Prashant Raghavan, MD Sugoto Mukherjee, MD Mark J. Jameson, MD, PhD, FACS Max Wintermark, MD vii

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11 Contents 1 Spaces of the Neck Christopher R. Durst, Mark J. Jameson, Max Wintermark, Prashant Raghavan, and Sugoto Mukherjee 1.1 Introduction Imaging Evaluation Parapharyngeal Space Masticator Space Carotid Space Posterior Spaces The Surgeon s Perspective Further Reading Lymph Nodes Sugoto Mukherjee, Mark J. Jameson, Max Wintermark, and Prashant Raghavan 2.1 Introduction Anatomy and Pathophysiology Imaging Evaluation CT and MRI Ultrasonography PET Posttreatment Evaluation of Residual/Recurrent Nodal Disease Other Pathology Lymphoma Papillary Thyroid Carcinoma Bacterial Infection Tuberculous and Mycobacterial Lymphadenitis Viral Infection Other Inflammatory Conditions The Surgeon s Perspective Further Reading ix

12 x Contents 3 Nasopharynx Sugoto Mukherjee, David C. Shonka Jr., Max Wintermark, and Prashant Raghavan 3.1 Introduction Anatomy and Physiology Pathology Imaging Evaluation Nasopharyngeal Carcinoma Nasopharyngeal Lymphoma Other Nasopharyngeal Lesions The Surgeon s Perspective Further Reading Oral Cavity and Oropharynx Sugoto Mukherjee, Brian M. Trotta, Mark J. Jameson, Max Wintermark, and Prashant Raghavan 4.1 Introduction Anatomy Squamous Cell Carcinoma Radiographic Staging Routes of Spread Radiographic Evaluation Posttreatment Imaging in Oral and Oropharyngeal Cancers Other Oral and Oropharyngeal Neoplasms Nonneoplastic Lesions Inflammatory Lesions of the Oral Cavity and Oropharynx Odontogenic Infections Infections of Salivary Gland Origin Tonsillar/Peritonsillar Infections, Peritonsillar Abscess Suppurative Lymphadenitis Necrotizing Fasciitis Ludwig s Angina Other Lesions The Surgeon s Perspective Oral Cavity Lesions Oropharynx Lesions Further Reading Larynx and Hypopharynx Prashant Raghavan, David C. Shonka Jr., Max Wintermark, and Sugoto Mukherjee 5.1 Introduction Anatomy Imaging Evaluation Squamous Cell Carcinoma Radiographic Staging Posttreatment Imaging

13 Contents xi 5.5 Other Laryngeal Neoplasms Infectious and Inflammatory Disorders Trauma Laryngocele Vocal Cord Paralysis Laryngeal Stenosis The Surgeon s Perspective Laryngeal and Hypopharyngeal Malignancy Other Laryngeal Pathology Further Reading Salivary Glands Prashant Raghavan, Mark J. Jameson, Max Wintermark, and Sugoto Mukherjee 6.1 Introduction Anatomy Imaging Evaluation Sialography Cross-Sectional Imaging Pathology Congenital Anomalies Infectious and Inflammatory Disorders Common Benign Tumors Mesenchymal Tumors Malignant Neoplasms Miscellaneous Disorders The Surgeon s Perspective Further Reading Orbits Thomas J.E. Muttikal, Prashant Raghavan, Max Wintermark, Steven A. Newman, and Sugoto Mukherjee 7.1 Introduction Anatomy Imaging Modalities Ultrasound Cross-Sectional Imaging Congenital/Developmental Anomalies Coloboma Persistent Hyperplastic Primary Vitreous Coats Disease Dermoids/Epidermoids Neurofibromatosis Type Vascular Anomalies Orbital Venous-Lymphatic Malformation (Lymphangioma) Venous Varix Cavernous Hemangioma

14 xii Contents 7.6 Infectious and Inflammatory Disorders Idiopathic Orbital Inflammatory Disease Sarcoidosis Wegener s Granulomatosis Thyroid Ophthalmopathy Optic Neuritis Benign Tumors Infantile Hemangioma Optic Nerve Meningioma Lacrimal Gland Benign Mixed Tumor Malignant Tumors Retinoblastoma Choroidal Melanoma Orbital Rhabdomyosarcoma Orbital Lymphoma Orbital Metastases Miscellaneous Retinal Detachment Choroidal Detachment The Surgeon s Perspective Further Reading Temporal Bone and Skull Base Prashant Raghavan, Bradley W. Kesser, Max Wintermark, and Sugoto Mukherjee 8.1 Anatomy External Ear Middle Ear Inner Ear Facial Nerve Jugular Foramen Imaging Evaluation Common Congenital Anomalies of the Temporal Bone External Auditory Canal (EAC) Atresia and Stenosis Middle Ear Anomalies Inner Ear Anomalies Inflammatory Disorders External Ear Inflammation Middle Ear and Mastoid Inflammation Petrous Apex Inflammation Facial Nerve Inner Ear Inflammation Trauma Vascular Abnormalities Arterial Abnormalities Jugular Bulb Anomalies Radiological Evaluation of Tinnitus

15 Contents xiii 8.7 Tumors and Tumorlike Lesions of the Temporal Bone and Skull Base External Auditory Canal (EAC) Tumors Middle Ear Tumors Tumors of the Facial Nerve Tumors of the Cerebellopontine Angle (CPA) Cistern, Internal Auditory Canal (IAC), and Labyrinth Osseous Tumors of the Temporal Bone and Skull Base Jugular Foramen Masses Miscellaneous Abnormalities Otosclerosis Superior Semicircular Canal Dehiscence (SSSD) Cerebrospinal Fluid Leaks The Surgeon s Perspective Further Reading Sinonasal Cavities Prashant Raghavan, Mark J. Jameson, Max Wintermark, and Sugoto Mukherjee 9.1 Anatomy and Physiology Nose and Nasal Cavity Paranasal Sinuses Anatomic Variations of Clinical Importance Physiology Imaging Evaluation Inflammatory Sinonasal Disease Acute Inflammation and Its Complications Fungal Sinusitis Chronic Rhinosinusitis (CRS) Noninfectious Inflammatory Conditions Sinonasal Neoplasms Malignant Neoplasms Benign Neoplasms The Surgeon s Perspective FESS Nasal Cavity and Sinus Tumors Further Reading Head and Neck Trauma David Clopton, Sugoto Mukherjee, J. Jared Christophel, Max Wintermark, and Prashant Raghavan 10.1 Introduction Imaging Evaluation The Facial Buttress Concept Fracture Patterns Nasal Fractures Naso-Orbital-Ethmoid (NOE) Fractures