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2
Prof. Hossam Thabet, M.D.
Otolaryngology-Head & Neck Surgery
Department
Alexandria University
īŽ Very common & A challenge for physicians
īŽ H & PE commonly lead to the correct diagnosis
īŽ An understanding of cervical embryology is
crucial in treatment of congenital &
developmental masses
īŽ Diagnosis and management of neck masses
need unique diagnostic skills and knowledge
of H & N anatomy, pathology, & radiology
Neck Mass
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3
Epidemiology
īŽ Adult neck masses are 90% malignant
īŽ Pediatric neck masses are rarely malignant.
īŽ Most common neck mass in children is an
enlarged reactive lymph node 2ry to
bacterial/viral infections
īŽ Almost 50% of all 2 Y/O children have
palpable normal cervical lymph nodes
Neck Mass
Physical Examination
īŽ Anatomical Considerations
īŽ Local Examination Of The Mass
īŽ Complete H & N Examination
īŽ Cranial Nerves Examination
īŽ General Examination
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Anatomical Considerations
īŽ Prominent Landmarks
īŽ Triangles of the Neck
īŽ Regional Anatomy
īŽ Lymph Node Levels
īŽ Carotid Bulb
īŽ Transverse Process of C1
Modified from Head and Neck Imaging, Mosby 2003
Level I
Level II
Level III
Level IV
Level V
Level VI
Level VII
IIB
IV
VB
VA
VI
VII
IA
IB
IIA
III
AAO-HNS (1988)
LYMPH NODE LEVELS
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Diagnostic Work Up
īŽ Imaging Studies
1. Ultrasonography
2. CT & CTA
3. MRI & MRA
4. Radiology; Chest, Neck, Sialography, barium swallow, Angiography
5. Radionucleotide scanning
6. PET & PET/CT
īŽ Endoscopy
īŽ Laboratory Work Up; (PPD,Gram stain,Culture)
īŽ Fine Needle Aspiration Biopsy (FNAB)
īŽ Surgical Biopsy
Gold Standard
Identification of Neck Masses
On Basis of their location
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Identification of Neck Masses On
Basis Of Their Location
Anterior Neck Swellings
Lateral Neck Swellings
Posterior Neck Swellings
Diffuse Neck Swellings
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Supraclavicular
Sub-
mandibular
Ant. to SCM
(Carotid Triangle)
Retro-
Mandibular
Along/ Deep
to SCM
Post. To SCM
Lateral Neck Mass
Midline
(Submental)
Anterior Neck Mass
īŽ Lymph Node
īŽ Abscess
īŽ Ludwigâs Angina
īŽ Dermoid
īŽ TGDC
īŽ Soft Tissue Neoplasm
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Lymph Node
Submental lymphoid tissue hyperplasia
Submental lymphadenitis
Submental Region
Lymph Node
Submental Region
Squamous Cell Carcinoma of the Lip: CECT; multiple Level I
submental metastatic lymph nodes with rim enhancement.
I A
I B
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Dermoid Cyst
Submental Region
īŽ Mesoderm & Ectoderm (Skin appendages)
īŽ Sublingual, submental or midline cervical mass
īŽ Painless & do not elevate with tongue protrusion.
īŽ Misdiagnosed as TGDC
īŽ D.D. by MRI & Intraoperative aspiration
īŽ Fat & fluid density
īŽ Treatment is simple excision
CECT, sublingual cyst with fat & fluid
attenuation. Faint peripheral
enhancement (arrows).
*
*
Between genohyoid & myelohyoid
Subligual
(Supramyelohyoid)
Dermoid
Clinical signs & surgical approach are determined by the
relationship of the cyst to the musculature of the FOM.
Submental
(Inframyelohyoid)
Dermoid
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A B C
*
*
Dermoid Cysts:
īŽ Thin-walled, unilocular, homogeneous,
hypoattenuating (0â18 HU) fluid on CT
īŽ âMarbles" appearance (Coalescence of fat into small nodules)
īŽ Hyperintense or isointense on T1-MRI.
īŽ Hyperintense on T2-MRI. Heterogeneous internal
appearance.
Epidermoid cysts: Fluid attenuation on CT.
Hypointense on T1- MRI & hyperintense on T2- MRI
Submental Region
Ludwigâs Angina
īŽ Cellulitis - Not an abscess
īŽ Sublingual & submandibular
spaces
īŽ 90% 2ry to dental infection
in the lower jaw
īŽ Foul, serosanguinous fluid,
no frank pus
īŽ Fascia, muscles & C.T.
involvement
CECT, multiple low attenuation (fluid) collections in sublingual (SL)& submandibular
(SM) spaces. No peripheral rim enhancement. An abscess on CT is an area of low
attenuation with rim enhancement
SL
SM
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Submental Region
Submental Abscess
CECT; a submental low attenuation with rim enhancement (arrow).
Inflammatory changes in the left submandibular region.
May be related to a dental or skin infection.
Submental Region
FOM Tumor
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Midline Thyrohyoid Region
Thyroglossal Duct Cyst
īŽ TGD extends from F. cecum through the hyoid bone to
pyramidal lobe of the thyroid.
īŽ Incomplete involution results in a TGDC
īŽ 80% infrahyoid
Rim enhancement if infected
Midline Thyrohyoid Region
Thyroglossal Duct Cyst
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Midline Thyrohyoid Region
Dermoid Cyst
1. Do not elevate with tongue protrusion (Not attached to
the hyoid bone)
2. MRI, variable T1 signal (Lipid) & No superior tract on
sagittal T2 MRI
3. Aspiration
âUsually misdiagnosed
as TGDCâ
Midline Thyrohyoid Region
Supraglottic Carcinoma
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Midline Thyrohyoid Region
Metastatic PTC
Midline Thyrohyoid Region
Hyoid Bone Tumor
īŽ Hirunpata S, et al.
Chondrosarcoma of the
Hyoid Bone: Imaging,
Surgical, and
Histopathologic Correlation.
American Journal of
Neuroradiology 27:123-125,
January 2006
Chondrosarcoma of the Hyoid Bone
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Midline
(PrelaryngeaL/Laryngeal)
Anterior Neck Mass
īŽ Thyroglossal DC
īŽ Dermoid
īŽ Laryngeal tumor
īŽ Hypopharyngeal tumor.
īŽ Retroph. Lesion
īŽ Thyroid (pyramidal lobe)
īŽ Thyroid (Accessory/ Ectopic)
īŽ TGDC Ca
īŽ Prelaryngeal L.N.
īŽ Teratoma
Midline (Prelaryngeal/Laryngeal)
Thyroglossal Duct Cyst
īŽ Most common congenital midline
neck mass (70%)
īŽ 2nd most common neck mass in
children after L.N.
īŽ Twice as common as BCC
īŽ 50% present before age 20y
īŽ 75% Midline or 25% paramedian
īŽ 65% infrahyoid (Midline or off-midline)
īŽ 20% suprahyoid (Tend to be midline)
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Midline (Prelaryngeal/Laryngeal)
Laryngeal Tumors
Transglottic Carcinoma with Extralaryngeal Spread
Midline (Prelaryngeal/Laryngeal)
Laryngeal Tumors
*
īŽ 95% of laryngeal carcinomas
are squamous cell carcinoma
īŽ Extralaryngeal spread into the
soft tissues in advanced cases
Laryngeal Carcinoma with Extralaryngeal Spread
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Midline (Prelaryngeal/Laryngeal)
Thyroid (Pyramidal Lobe PTC)
PTC in a pyramidal lobe
CECT; a homogeneous mass with rim
enhancement in the anterior neck
(arrow).
Midline (Prelaryngeal/Laryngeal)
Lymph Node
īŽ Non Hodgkin's Lymphoma,
īŽ Delphian nodes (Anterior
Jugular Nodes).
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Midline (Prelaryngeal/Laryngeal)
Abscess
*
īŽ Occur anywhere in the neck
īŽ Low attenuation mass with rim
enhancement
īŽ Tender mass with overlying skin
erythremia
īŽ Fever & elevated WBC count
īŽ Necrotic lymph nodes should be
excluded in any adult with a lesion
that has this appearance.
CECT; a low attenuation mass (*) with peripheral rim enhancement in the anterior neck. The
overlying skin & platysma muscle (arrow) are thickened with subcut. inflammatory changes.
Anterior Neck Mass
īŽ Thyroid mass
īŽ Dermoid cyst
īŽ Branchial cyst (infant)
īŽ Pretracheal L.N
īŽ Thymic mass or cyst
īŽ Mediastinal mass
īŽ Anomalous CA/innomiate.
īŽ AJ phleboectasia
īŽ Cong. Midline cervical cleft
īŽ Lipoma
īŽ Teratoma
Midline
(Suprasternal&Pretracheal(
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Thyroid Masses
Midline (Supraternal & Pretracheal)
Follicular Adenoma,
hemithyroidectomy
Hashimotoâs
Thyroiditis
Midline (Supraternal & Pretracheal)
Mass was mobile with degluitition but not with tongue protrusion
Thyroglossal Duct Cyst
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Midline (Supraternal & Pretracheal)
Congenital Midline Cervical Cleft
īŽ Rare anormaly
īŽ Not a true cleft, no skin gap
īŽ Between mandible & manubrium.
īŽ Asymptomatic
īŽ Overlooked at birth
īŽ Clinical Diagnosis
īŽ Upper skin protuberance & lower blind
mucosal tract
īŽ Subcut. fibrous cord from the skin tag
to chin
AJ phleboectasia
a dilated Lt. AJV CTA , aneurysm of the Lt. AJV
Normal DSA of Arch
of Aorta & neck vs,
Midline (Supraternal & Pretracheal)
Jugular Vein Phlebectasia
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Midline (Supraternal & Pretracheal)
Thymus gland anomalies
Cervical thymoma
īŽ Firm, mobile masses in the lower neck
īŽ Decrease with inspiration (Characteristic)
īŽ 1st decade of life.
īŽ Chest Xray & CT.
īŽ Surgical excision is the treatment of choice.
Paramedian
(Paralaryngeal).
Paramedian
(Paratracheal)
Anterior Neck Mass
īŽTGDC
īŽLaryngeal Tumor
īŽHypopharyngeal Tumor
īŽLaryngocele
īŽSaccular Cyst
īŽPharyngeal Pouch
īŽBranchial Cyst
īŽ Thyroid mass
īŽ Parathyroid mass
īŽ Metastatic L.N
īŽ Peristomal rec.
īŽ Branchial cyst
īŽ Esoph. & tracheal
Diverticulum
īŽ Pneumocele
īŽ Thymic mass/cyst
īŽ Anomalous Carotid
īŽ AJ phleboectasia
īŽ Bronchogenic Cyst
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Anterior Paramedian Region
Thyroglossal Duct Cyst
Laterally located infrahyoid TGDC with rim enhancement
Laryngeal Tumors
Transglottic Carcinoma with Extralaryngeal Spread
Anterior Paramedian Region
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Anterior Paramedian Region
Papillary Thyroid Carcinoma
Anterior Paramedian Region
Congenital Cervical Lung Herniation
īŽ The least common location
of lung herniation.
īŽ Patients <3 years of age
īŽ Unilateral or bilateral,
īŽ Congenital; parietal pleura
is intact
īŽ Traumatic; parietal pleura is
disrupted
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Anomalous Carotid Artery
Anterior Paramedian Region
Cervical Bronchogenic cyst
īŽ Rare anomalies due to abnormal
tracheobronchial development
īŽ Extrathoracic suprasternal or
presternal.
īŽ Intrathoracic in the mediastinum,
diaphragm, pericardium, or lung
īŽ The definitive treatment is
surgical excision
Anterior Paramedian Region
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Supraclavicular
Sub-
mandibular
Ant. to SCM
(Carotid Triangle)
Retro-
Mandibular
Along/ Deep
to SCM
Post. To SCM
Lateral Neck Mass
Submandibular
īŽ SMG Swellings
īŽ Lymph Node
ī Lymphadenitis
ī Atypical mycobacteria
ī Cat scratch disease
ī Metastatic
īŽ Abscess
īŽ Plunging Ranula
īŽ PPS tumor
īŽ Soft tissue Tumors
e.g. lipoma..etc
Lateral Neck Mass
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SMG enlargement may
be 2ry to:
1. Tumor in the gland
2. Stone obstruction
3. FOM carcinoma
compressing the duct
Submandibular Region
s
Submandibular Chronic Sialadenitis with Stone
Submandibular Region
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Submandibular Space Abscess
īŽ May be 2ry to dental infection
īŽ D.D. a necrotic L.N. with extracapsular extension of
īŽ Clinical history is key
a multiloculated low- attenuation mass with peripheral rim enhancement in the Lt SM
space.
A B
Submandibular Region
Submandibular Region
Submandibular Sialadenitis
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Floor Of Mouth Carcinoma
âĸ 90% occur in the anterior FOM
âĸ Cause obstruction of the S.M.duct
âĸ Present with a hard submandibular L.N. or an enlarged S.M.G.
CECT (A) shows a mass (*) in the anterior FOM causing obstruction of the left
SM.duct (arrow). (B) shows enlargement of the left SMG (arrow).
A B
*
Submandibular Region
Submandibular Lymph Node Hyperplasia
Submandibular Region
Level IB L.N.
âHomogenous lymph nodes are often
encountered in patients with Lymphoma,
Sarcoidosis or Reactive lymphoid hyperplasiaâ
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Submandibular Region
Submandibular Atypical
Mycobactrial Lymphadenitis Level IB L.N.
S S
Submandibular Region
Cervical Lymphadenitis
Enhanced CT shows multiple masses with rim enhancement in the right submandibular
region.
Level IB & IIA L.N.
Cat Scratch Disease
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Submandibular Region
Granulomatous Sialadenitis
Sarcoidosis Xanthogranuloma
Submandibular Gland Tumor
âĸ 50% malignant (Adenoid cystic & mucoepidermoid
carcinoma)
a heterogenous mass enlarging the gland & almost replacing the entire glandular tissue.
A B
Submandibular Region
Benign Mixed Tumor.
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CECT (A) shows a low density lesion in the sublingual space (arrow) that extends
posterior medial to the SMG(B). This lesion can be differentiated from a branchial cleft
cyst when a portion of the lesion is identified in the sublingual space (tail sign).
B
SM
A
SM
SL
M
SM
Submandibular Region
Plunging Ranula
Plunging Ranula
SM
The pathognomonic radiological sign for plunging ranula is
the presence medial to the SMG, & presence of the tail sign
Submandibular Region
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Ant. To SCM
(Carotid Triangle)
īŽ Normal; hyoid, thyroid c., & carotid bulb
īŽ Lymph Node (Jugulodigastric)
īŽ Branchial Cyst II, III,IV
īŽ CBT/ G. Vagale
īŽ Schwannoma
īŽ Laryngocele
īŽ Lat.Saccular Cyst
īŽ Pharyngeal Pouch
īŽ Carotid anurysm
īŽ Phleboectasia (I.J.V
īŽ Hemangioma
īŽ Lymphangioma
Lateral Neck Mass
Carotid Triangle
Cervical Lymphadenitis
Atypical Mycobacterial Cervical Lymphadenitis
Level II A & B L.N.
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Carotid Triangle
Branchial Cyst
2nd Arch Branchial Cleft Cysts
SMG
SCM
Carotid Triangle
Branchial Cyst
SCM
*
C
Diagram (A) a BCC with reference to SCM. Axial CECT (B) and sagittal image (C) show a low
attenuation, well-circumscribed mass anterior to SCM with anterior displacement of the
submandibular gland (SM) and posterior medial displacement of the carotid sheath structures. Axial
T2WMR (D) shows the anterior aspect of the SCM being flattened by this high-signal intensity cyst
A
*
SM
*
B
D
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Carotid Triangle
Metastatic Lymph Node
Bilateral low attenuation JD nodes
(Level II) with rim enhancement in
a patient with a tonsillar
carcinoma.
Level II A L.N.
Carotid Triangle
Metastatic PTC
Metastatic PTC. Level IIa & III
Level II A & III L.N.
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Carotid Triangle
B-Cell Lymphoma Level II A & III L.N.
Carotid Triangle
Schwannoma
A B
(A) an enhancing mass in the left carotid space causing splaying of carotid sheath
structures. MRA shows splaying of the carotid bifurcation with no neovascularity (B)
īŽ Occur in the same locations as paragangliomas.
īŽ May enhance on CT similar to paragangliomas.
īŽ MR, MRA, or CTA can exclude paraganglioma (no
neovascularity or salt & pepper pattern)
IJV
M
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Carotid Triangle
A
Carotid Body Tumor
B
Axial CECT (A) & CTA (B) show an enhancing mass splaying the carotid arteries.
The ICA (arrow) is displaced posteriorly & ECA anteriorly (arrow).
IJV
M
īŽ Signal voids on MRI & evidence of neovascularity is
noted on MRA & CTA.
Carotid Triangle
Carotid Body Tumor
CBA
Axial T1WI (A( an intermediate signal intensity mass with typical âsalt and pepperâ
appearance caused by flow voids (vessels = pepper) & areas of subacute hemorrhage
(salt). There is anterior displacement of ECA (arrows). & posterior displacement of ICA
(arrows). The lesion enhances on post contrast FST1WI (B). The splaying of the carotid
bifurcation and enhancement of the lesion are seen on MRA (C).
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Carotid Triangle
Lateral Saccular Cyst (Laryngoscleroma)
Bilateral saccular cyst , Rhino-laryngo-tracheoscleroma
Huge lateral saccular cyst herniating through the thyrohyoid membrane into the soft
tissues of the neck
īŽ Saccular cyst is a mucous filled dilatation of the saccule that
does not communicate with the laryngeal lumen.
īŽ âEarly obstruction of the saccule opening results in the
accumulation of fluid in the saccule with no presence of airâ
īŽ Can be distinguished from laryngoceles in that there is no
communication with the laryngeal lumen, they do not contain
air (No air fluid level) & located submucosally
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Carotid Triangle
Carotid Artery Aneurysm
Rt. ICA Aneurysm
īŽ Mostly 2ry to atherosclerosis
īŽ May be due to degeneration,
infection (mycotic forms),
congenital, trauma,
fibromuscular dysplasia,
irradiation arteritis, dissecting
aneurysm or non-specific
causes
īŽ Present commonly with
pulsatile neck swelling.
īŽ Other Sx include pain, TIA,
stroke and dysphagia.
Post. To SCM
(Posreior Triangle)
īŽ Lymph Nodes
ī Lymphadenitis
ī T.B
ī Metastatic
īŽ Soft tissue tumors;
(Lipoma, sarcoma)
īŽ Lymphangiomas
īŽ Neural tumors
īŽ Lesions of the vertebral axis
Lateral Neck Mass
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Posterior Triangle
Lymph Node
Cervical Lymphadenitis, Kawasaki Disease
Level II B & VA L.N.
Posterior Triangle
TB Lymphadenitis
BA
Bilateral heterogenous enhancing L.N.
Level III & V L.N.
Posterior triangle L.N. enlargement may be due to;
1. TB
2. Lymphoma ( especially Hodgkinâs Lymphoma(
3. Head and neck cancer
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Posterior Triangle
Lymphangioma
*
*
*
s
A
B
C
*
īŽ Uni or multiloculated, non-enhancing
īŽ Capillary, cavernous, & cystic
īŽ Large, soft, compressible masses
īŽ Posterior vs. anterior triangle location
īŽ Do not transilluminate.
īŽ CT scan
īŽ Spontaneous regression is rare
īŽ Surgical excision is the treatment of choice.
īŽ Sclerotherapy with OK-432
CECT (A) a low attenuation mass (*) medial & ant.to SCM (S). Axial TIMRI (B) a hypointense
mass that increases in signal intensity on T2MRI (C). Septations are seen in the lesion on
T2WI.
Nerves In The Neck
Cervical sympathetic
chain
Vagus nerve
Recurrent LN
Phrenic nerve
Cervical nerve
root
You must be familiar with the location of the
nerves in the neck when evaluating for a possible
neural tumor.
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Posterior Triangle
Neural Tumors
A B
The location of the lesion may be the key to diagnosis.
CECT (A) multiple bilateral low attenuation, vagal and cervical nerve root lesions in a
patient with neurofibromatosis. A heterogeneously-enhancing mass is seen in the left
prevertebral region (B). This sympathetic chain schwannoma is causing anterior
displacement of the carotid sheath structures (circle).
Posterior Triangle
Neural Tumors: Neurofibromatosis
Axial T1WI (A & B( a âdumbbell â shaped homogeneous, isointense mass in the left
posterior cervical space that extends from the spinal canal and enlarges the neural
foramen (arrows). The intraspinal component (arrow) is seen on the coronal T2 MRI (C).
â When you have a mass in the posterior triangle, look
for evidence of communication with the spinal canal or
adjacent nervesâ
A B C
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Posterior Triangle
Neural Tumors
(A) a heterogenous mass with a low attenuation center in the Rt. posterior cervical
space (arrow). Sequential image (B) shows an enlarged cervical nerve root passing
between the anterior (A) & middle (M) scalene muscles leading to the mass. This finding
suggests the diagnosis of a neurogenic lesion.
A
B
M
A
A
M
Schwannomas
Posterior Triangle
Metastatic disease
âCommonly presents as an asymmetric mass that
involves cervical lymph nodes or vertebraâ
A B
Metastatic breast Ca: (A) an expansile lytic lesion involving the vertebral body &
posterior elements. Metastatic melanoma: (B) a large, centrally-necrotic mass in the
right paraspinal muscles.
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Posterior Triangle
Rhabdomyosarcoma
1. Ill defined
2. Enhancing soft tissue density
3. Areas of necrosis
Malik et al, 2002
īŽ Most common solid H & N
tumor in children
īŽ Symptoms related to tumor site
īŽ Rapidly growing, <1 month
before diagnosis
īŽ Complete resection if possible
īŽ Chemotherapy with radiation
and/or surgical salvage has
cure rates of 50-65%
Posterior Triangle
Embryonal Rhabdomyosarcoma
īŽ 10-15% of all solid tumors.
īŽ Median age = 5y
īŽ Aggressive tumor
īŽ Occur in multiple sites
īŽ 35-50% originate in H & N
īŽ Metastases in lungs, L.Ns,
mediastinum, brain, liver, &
skeleton.
īŽ Surgical excision, with
adjunctive chemotherapy &
radiation therapy
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Posterior Triangle
External Jugular V. Phleboectasia
īŽ Rare anomaly - An isolated fusiform
or saccular dilatation of a vein
īŽ Affect IJV, EJV, AJV, sequentially.
īŽ An intermittent neck swelling during
straining & Valsalva manoeuvre .
īŽ Diagnosis is confirmed by Doppler
US, CE. CT,CTA, MRA & MR
venography.
īŽ Surgical excision for symptomatic
patients or for cosmetic reasons.
Along /Deep to SCM
īŽ Lymph nodes
ī Lymphadenitis
ī T.B
ī Metastatic
īŽ SCM tumor of infancy
īŽ SCM pseudotumor
īŽ Lipoma
īŽ Lymphangiomas
īŽ Neural tumors
īŽ IJ Phleboectasia
Lateral Neck Mass
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Along/Deep To SCM
SCM Tumor of Infancy (Fibromatosis Colli)
Along/Deep To SCM
Jugular Vein Phlebectasia
īŽ Only 5 Pediatric neck swelling enlarge on Valsalva
manoeuvre :
1. Phlebectasia (Venous Aneurysm )
2. Laryngocele or lateral saccular cyst
3. Superior Mediastinal tumor
4. Tracheocele or Tracheal diverticulum
5. Cervical apical Lung herniation
IJ Phleboectasia
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Supraclavicular
īŽ Fat pad
īŽ Lymph nodes
ī Granulomatous
ī Metastatic
ī Lymphoma
īŽ Lipoma
īŽ Cystic hygroma
īŽ Pneumatocele
īŽ Cervical rib
īŽ Chyloma
īŽ Hypertrophy of sternoclavicular joint/ clavicle
Lateral Neck Mass
Supraclavicular Region
Supraclavicular Lymphadenopathy
īˇ Left supraclavicular lymph nodes (The Virchow node)
may represent:
1.Metastasis from distant malignancy (abdominal or
thoracic), particularly lung (bronchogenic ca.), breast & GIT
(stomach, esophagus)
2.Non-Hodgkin lymphoma, Hodgkin disease.
3.Mediastinal disease (lymphoma, TB, atypical mycobacterial
infection, or sarcoid)
4.Chronic fungal & mycobacterial infections (eg,
scrofula)
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Supraclavicular Region
Lymph Nodes
īŽ 35% of patients with H&N lymphoma present with a
supraclavicular mass
īŽ 35% of pts with suprclavicular masses had lymphoma
Torsiglieri et al., 1988
Lymphoma
Supraclavicular Region
Lymph Nodes
SCM
Nontuberculous Mycobacterial Lymphadenitis
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Supraclavicular Region
Chyloma
A well defined negative density collection is seen in the
retro-esophageal space in the right supraclavicular region
Chyloma
Supraclavicular Region
Cervical Rib
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Posterior Neck
(Occipital/Median/Paramedian)
īŽ Lymph node
īŽ Lymphadenitis
īŽ Metastatic
īŽ Lymphoma
īŽ Abscess
īŽ Lipoma
īŽ Meningocele
īŽ Encephalocele
īŽ Neural tumors
īŽ Vertebral lesions
Lateral Neck Mass
Posterior Neck
Lymph Node
Enlarged occipital & spinal accessory lymph
nodes may present as posterior neck masses.
A B
Lymphoma: CECT (A and B) show enlarged homogenous occipital lymph
nodes (arrows).
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Posterior Neck
Carbuncle / Furuncle
īŽ A furuncle is an acute, round, firm, tender,
circumscribed, perifollicular staphylococcal pyoderma
that usually ends in central suppuration.
īŽ A carbuncle is two or more confluent furuncles with
separate heads
Posterior Neck
Hemangioma Lipoma
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Madelungâs Disease
Diffuse Neck Swellings
īŽ Middle-aged (50 y) alcoholic males
īŽ Non-encapsulated fatty masses
īŽ At least 10 years of heavy drinking
īŽ Typical lipomas are encapsulated
Lymphoma / Leukemia
Diffuse homogeneous cervical lymphadenopathy in
adults is often encountered in patients with
lymphoma & leukemia.
Diffuse homogeneously-enlarged cervical lymph nodes.The lingual tonsils are also
enlarged (circle).
A B
Diffuse Neck Swellings