Interesting cases

CT SCAN

05/07/2014

• 23 YR F PT

• C/O ……..

Imaging Findings

• Best diagnostic clue: Cystic mass around pinna and EAC (type I) or extending from EAC to angle of mandible (type II)

• Well-circumscribed, non enhancing or rim-enhancing, low-density mass

• If infected, may have thick enhancing rim or be dense internally

Top Differential Diagnoses

• *Benign Lymphoepithelial Cysts• *Venolymphatic Malformation (VLM)• *Suppurative Adenopathy/Abscess• *Nontuberculous Mycobacterial Adenitis

First Branchial Cleft Cysts

First Branchial Cleft Cyst,

First Branchial Cleft Cysts

• Accounts for 8% of all branchialapparatus remnants

• Most common location for 1st BCC to terminate is in EAC between its cartilaginous & bony portions

Second Branchial Cleft Cysts

• Most Common (90%) branchial anomaly• Painless, fluctuant mass in anterior triangle• Inferior-middle 2/3 junction of SCM, deep to

platysma, lateral to IX, X, XII, between the internal and external carotid and terminate in the tonsillarfossa

Second Branchial Cleft Cysts

Imaging Findings

• Low density cyst with non enhancing wall & surrounding soft tissues, unless infected

• If infected, wall is thicker & enhances with surrounding soft tissues appearing "dirty" (cellulitis) or internally dense

Top Differential Diagnoses

• Lymphangioma• Thymic cyst• Suppurative jugulodigastic node• Cystic vagal schwannoma• Cystic malignant adenopathy (ALWAYS CONSIDER THIS

POSSIBILITY IN ADULTS!)

Second Branchial Cleft Cysts

Second Branchial Cleft Cysts

• * Epidemiology: 2nd BCC account for > 90% of all branchial cleft anomalies in teens and adults, 66-75% in children

• * Most common signs/symptoms: Painless, compressible lateral neck mass in child or young adult

• * Neck mass often chronic, recurrent, increasing in size with upper respiratory tract infection

• * Beware an adult with first presentation of "2nd BCC”

• * Mass may be metastatic node from head & neck SCCa primary tumor

Third Branchial Cleft Cysts

• Rare (<2%)• Similar external presentation to 2nd BCC• Internal opening is at the pyriform sinus, then

courses cephalad to the superior laryngeal nerve through the thyrohyoid membrane, medial to IX, lateral to X, XII, posterior to internal carotid

Third Branchial Cleft Cysts

Third Branchial Cleft Cysts

Imaging Findings

*Best diagnostic clue: Unilocular thin-walled cyst in posterior cervical space (posterior triangle)*May occur anywhere along course of 3rd branchial cleft or pouch

Top Differential Diagnoses

* 2nd branchial cleft cyst* 4th branchial cyst* Lymphangioma* Infrahyoid thyroglossal duct cyst* Suppurative adenopathy* External laryngocele* Cystic-necrotic lymph node

Fourth Branchial Cleft Cysts

• Courses from pyriform sinus apex caudal to superior laryngeal nerve, to emerge near the cricothryoid joint, and descend superficial to the recurrent laryngeal nerve.

Fourth Branchial Cleft Cysts

Fourth Branchial Cleft CystsImaging Findings

* Best diagnostic clue: Unilocular thin-walled cyst in superior lateral aspect of LEFT thyroid lobe with associated thyroiditis* May occur anywhere from LEFT pyriform sinus apex to thyroid lobe* Morphology: Unilocular & thin-walled unless infected

Top Differential Diagnoses

* Thyroglossal duct cyst* Thymic cyst* 3rd branchial cleft cyst* Lymphangioma* Thyroid colloid cyst* Parathyroid cyst* Thyroid abscess

• 51 YR FEMALE PT

• K/C/O……ON FOLLOW UP

• OPERATED CASE OF SIGNET RING CELL CARCINOMA OF STOMACH

• ON REGULAR FOLLOW UP.

• CT F/S/O METSTATIC DEPOSIT IN RIGHT OVARY

• Krukenberg tumour

SPOTTER

• PSEUDOMYXOMA PERITONEI

• 55 yr Male

• c/o cough with occ. hemoptysis

• Neck pain

• 40 yr MALE

• H/O ???????????

• BRAIN METS IN K/C/O CLEAR CELL SARCOMA

• 45 YR MALE

• C/O DISTENSION OF ABDOMEN

• SIGMOID VOLVULUS

• 47YR MALE

• C/O PAIN AND JAUNDICE

• HP PROVEN LYMPHOMA

• 13 YR MALE PATIENT

• MYOSITIS OSSIFICANS

• Myositis ossificans (MO) is a benign process characterised by heterotopic ossification usually within large muscles.

• CT SCAN demonstrating mineralisationproceeding from the outer margins towards the centre. The cleft between it and the subjacent bone is usually visible.

SPOTTER

• ACUTE PTE

SPOTTER

• Condylus Tertius

THANK YOU