Hyperattenuating paranasal sinus opacification can arise in a number of situations:
fungal sinus disease
acute haemorrhage into sinus (haemosinus)
In some situations can consider early calcification within the sinus.
Hyperostosis of the skull has many causes, broadly divided into focal or diffuse.
Paget's disease of bone
metastatic disease, especially prostate carcinoma
chronic, severe anaemia
hyperostosis frontalis interna
long-term phenytoin use...
Hyperparathyroidism is the effect of excess parathyroid hormone in the body. It can be primary, secondary, or tertiary. There are many characteristic imaging features, predominantly involving the skeletal system.
Increased levels of the parathyroid hormone lead to increased osteoclas...
Hypertelorism refers to an abnormal increase in distance between any two organs although some authors use the term synonymously with orbital hypertelorism meaning an abnormal increase in distance between the two eyes. The article mainly focuses on the latter. The abnormality is similar to teleca...
Hypodontia refers to the congenital absence of one or more teeth.
Hypodontia is common, affecting ~15% of the population with a recognised variations in ethnicities, e.g. prevalence of 1% in indigenous Australians through to 30% in Japanese populations. There is a female preponder...
Hypoglobus refers to the inferior displacement of the globe into the orbit. It may or may not be associated with enophthalmos.
Hypoglobus is most commonly caused by fracture of the orbital floor but may be due to other causes:
silent sinus syndrome
orbital foreign bodies
The hypoglossal canal is located between the occipital condyle and jugular tubercle and runs obliquely forwards (posteromedial to anterolateral) allowing the hypoglossal nerve (12th cranial nerve) to exit the posterior cranial fossa.
Its proximal portion is often divided by a fibrous (sometime...
Hypoparathyroidism results from reduced secretion of parathyroid hormone by the parathyroid glands. It results in hypocalcaemia.
tetany: peripheral paresthaesia, carpopedal spasm, seizures
emotional lability, depression and anxiety, psychosis
Squamous cell carcinoma of the hypopharynx is relatively uncommon, carries the worst prognosis of any head and neck squamous cell carcinoma (HNSCC), and is a challenge to diagnose and treat.
Hypopharyngeal carcinoma is relatively uncommon representing only 10% of all proximal aerodigestive tra...
Staging of hypopharyngeal squamous cell carcinoma is performed using the TNM staging system.
Primary tumour staging (T)
limited to 1 subsite AND
tumour size ≤ 2 cm in greatest dimension
extends into adjacent subsite or area (larynx, oropharynx) and/or
tumour size betw...
T staging of hypopharyngeal tumours is as follows:
The hypopharynx includes the pyriform sinuses, the lateraland posterior hypopharyngeal walls, and the postcricoid region.
T1: tumour is limited to one subsite of the hypopharynx and 2 cm or less in greatest dimension
T2: tumour in...
The hypopharynx or laryngopharynx forms the most inferior portion of the pharynx, being the continuation of the oropharynx superiorly and both the larynx and oesophagus inferiorly.
The hypopharynx begins as the continuation of the oropharynx at the pharyngoepiglottic fold (which...
Hypotelorism refers to an abnormal decrease in distance between any two organs although some authors use the term synonymously with orbital hypotelorism meaning an abnormal decrease in the distance between the two eyes (the eyes appear too close together). The article mainly focuses on the latte...
The hypotympanum refers to the portion of the tympanic cavity lying inferior to the level of the inferior margin of the external acoustic canal (EAC).
The hypotympanum is the smallest of the three compartments that make up the tympanic cavity and is a shallow depression in the fl...
Hyrtl's fissure (also known as tympanomeningeal fissure) is a congenital infralabyrinthic fissure. It is a very rare cause of spontaneous CSF ottorhoea and meningitis.
This fissure is present in the developing fetal petrous temporal bone and is typically ossified by 24 weeks.
I-131 (or 131I) is a radioisotope used in the diagnosis and treatment of thyroid lesions. It is one of the oldest radiotracers used in nuclear medicine, in use for over 50 years. It is predominately used in thyroid ablation therapy, for patients post thyroidectomy, and for metastatic thyroid ca...
The ice cream cone sign may refer to:
the appearance of the head of malleus and the body and short process of the incus on axial CT scan: failure of this normal configuration suggests incudomalleolar dysarticulation
the ball of the ice cream is formed by the head of the malleus and cone is for...
Idiopathic orbital inflammation (IOI), also known as orbital pseudotumour and nonspecific orbital inflammation, is an idiopathic inflammatory condition that most commonly involves the extraocular muscles. Less commonly there is inflammatory change involving the uvea, sclera, lacrimal gland, and ...
IgG4-related disease (IgG4-RD) is a systemic disease that is characterised by extensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs.
This condition has been known by many other names in the past, such as IgG4-related sclerosing disease, IgG4-related s...
The maxillary incisive canal runs through the maxilla in the midline. It connects the inferior nasal cavity with the superior oral cavity, opening at the incisive foramen posterior to the central maxillary incisor teeth. It contains the descending palatine artery and the nasopalatine nerve.
Incisive canal cysts, also known as nasopalatine duct cysts (NPDC), are developmental, non-neoplastic cysts arising from degeneration of nasopalatine ducts. These ducts usually regress in fetal life. The persistence of ductal epithelium leads to formation of cyst.
It is considered the most comm...
The incisive foramen (also known as nasopalatine foramen or anterior palatine foramen) is the oral opening of the nasopalatine canal. It is located in the maxilla in the incisive fossa, midline in the palate posterior to the central incisors, at the junction of the medial palatine and incisive s...
The incisive nerve is one of the two terminal branches of the inferior alveolar nerve, a branch of the posterior division of the mandibular division of the trigeminal nerve. It continues running anteriorly in the medullary cavity of the mandible after the mental nerve branches off and exits via ...
The incus is the middle of the ossicles articulating with the head of the malleus anteromedially and the stapes inferomedially.
a body which articulates with the head of the malleus, and to which the superior ligament of the incus is attached (to the roof of the middle ear cavit...
Infantile cervical ligament oedema can typically be seen when infants have suffered accidental or abusive head and neck trauma. The finding is best seen on sagittal STIR images.
The posterior ligamentous complex refers to the ligamentum flavum and interspinous ligaments. The anteri...
Infantile haemangiomas are benign vascular neoplasms that are the most common head and neck tumours of infancy. They can occur virtually anywhere, but the majority are found in the head and neck regions.
This article aims to be a generic discussion of the condition, for detailed and more specif...
The inferior alveolar artery is a branch of the maxillary artery. It runs with the inferior alveolar nerve as it descends through the infratemporal fossa and enters the mandibular canal and supplies mandibular teeth. In the region of the first premolar it bifurcates into the incisive and mental ...
The inferior alveolar nerve or inferior dental nerve is a mixed sensory and motor branch of the posterior division of the mandibular division of the trigeminal nerve in the pterogomandibular space of the oral cavity.
The inferior alveolar nerve divides off the posterior division ...
Inferior labial artery (old name: inferior coronary artery) is one of the facial branches of the facial artery. It is smaller than the superior labial artery. It supplies the lower lip, including its labial glands, mucous membranes and muscles.
origin: facial branch of the facial arter...
The inferior longitudinal muscle of the tongue is one of the 4 intrinsic muscles of the tongue which alters the shape of the tongue mass, being entirely confined to the tongue without an attachment outside the tongue (like the extrinsic muscles of the tongue).
The muscles fibres ...
The inferior meatus is an air passage of the lateral nasal cavity located between the inferior nasal concha and lateral nasal wall. The nasolacrimal duct drains into the inferior meatus.
The plural of meatus is meatus (Latin noun of the fourth declension) or meatuses. Meati is inco...
The inferior median clival canal also known as the canalis basilaris medianus is a rare anatomical variant of the clivus, which passes in the sagittal plane from the intracranial surface of the clivus to its retropharyngeal surface. It is generally thought to represent a remnant of the notocord....
The inferior nasal conchae or turbinates are one of the pairs of conchae in the nose.
It extends horizontally along the lateral wall of the nasal cavity and consists of a lamina of spongy bone, curled upon itself like a scroll. The inferior nasal conchae are considered a pair of ...
The inferior oblique muscle is one of six extra-ocular muscles that control eye movements.
innervation: inferior branch of the oculomotor nerve (CN III)
origin: orbital surface of the maxilla
insertion: globe (posterior, inferolateral surface)
primary function: one of two ocular ext...
The inferior ophthalmic vein (IOV) is a vein of the inferior orbit and is smaller than the more well known superior ophthalmic vein.
The vein forms at the confluence of several veins within the anteroinferior orbit along the infraorbital margin from facial vein tributaries. It co...
The inferior pharyngeal constrictor muscle is one of the pharyngeal constrictor muscles. It has a sphincteric function, and physiologically is usually in a tonic state, constricting the distal end of the pharynx (in coordination with the superior pharyngeal constrictor and the middle pharyngeal ...
The inferior rectus muscles is one of the 6 extra-ocular muscles that control eye movements.
innervation: inferior branch of the oculomotor nerve (CN III)
origin: Annulus of Zinn (tendinous ring)
insertion: globe (anterior, inferior surface)
primary function: one of two ocular depre...
The inferior thyroid artery is a branch of the thyrocervical trunk (85%) or subclavian artery (15%) and ascends to enter the thyroid gland on its posterior surface, as well as supplying both the superior and inferior parathyroid glands 1. The nerve is closely related to the ascending limb of the...
The infrahyoid muscles or strap muscles are a group of four paired muscles in the anterior neck below the hyoid bone, within the muscular triangle. They are responsible for depressing the hyoid during swallowing.
The four muscles are:
sternohyoid: superficial and medial
omohyoid: superficial ...
The infraorbital artery is a branch of the third part of the maxillary artery. It runs through the inferior orbital fissure, orbit, infraorbital canal then the infraorbital foramen. Here it gives off the anterior superior alveolar artery which supplies the anterior teeth and the anterior part of...
The infraorbital foramen is located in the maxillary bone. It is the anterior opening of the infraorbital canal, which is the anterior continuation of the infraorbital groove, which course through the floor of the orbit. The canal may reside entirely in the maxillary sinus, suspended from the si...
The infraorbital nerve is a branch of the maxillary division of the trigeminal nerve.
The infraorbital nerve divides off the maxillary division just after emerging from the foramen rotundum to enter the pterygopalatine fossa. It courses laterally over the palatine bone and maxi...
The infratemporal fossa is a complex space that lies posterolateral to the maxillary sinus and many important nerves and vessels traverse it.
The infratemporal fossa is the space between the skull base, lateral pharyngeal wall and the ramus of mandible. The fossa communicates w...
The infratrochlear nerve is an extraconal branch of the nasociliary nerve, a branch of ophthalmic division of the trigeminal nerve. Some authors describe it as the terminal branch of the nasociliary nerve. It courses through the medial aspect of the extraconal space of the orbit inferior to the ...
Ingested bones that become lodged in the throat or gastrointestinal tract are a common presentation to the emergency department. Recognition is important because these cases can be potentially fatal.
Patients may present with a 'foreign body' feeling in the throat after eating fish ...
The inion is the tip of external occipital protuberance (EOP), the midline bony prominence in the occipital bone where the ligamentum nuchae and trapezius muscle attaches. It is usually easily palpable.
It is the the surface marking of the internal attachment of the tentorium cerebelli.
It is ...
The inner ear refers to the bony labyrinth, the membranous labyrinth and their contents. It is divided into three main parts:
A useful mnemonic to remember innervation of the muscles of the middle ear is:
S for Stapedius
T for Tensor Tympani
S: stapedius is supplied by a branch of the facial nerve - the Seventh cranial nerve. It is also the Smallest muscle in the body, and inserts onto the neck of Stapes.
Inspissated colloid (colloid crystals) in a thyroid nodule leads to focal hyperechogenic foci, which can potentially be confused with microcalcifications.
hyperechoic focus in a thyroid nodule
reverberation artifact / comet-tail artifact
this feature is the most reliabl...
Internal auditory canal (IAC) diverticulum, also referred to as cavitary plaque, is a small focal outpouching arising from the anterolateral wall of the IAC.
In one study, they were identified in 5% of petrous temporal bone CT-scan 1. In the same study, it was coexisting with otos...
A mnemonic to remember the relative position of nerves inside the internal auditory canal (IAC) is:
Seven up, Coke down
Four nerves pass through the IAC:
facial nerve (CN VII)
three components of the vestibulocochlear nerve (CN VIII)
cochlear nerve (CN VIIIc)
superior vestibular n...
The internal jugular vein (IJV) is the major venous return from the brain, upper face and neck.
Origin and course
It is formed by the union of inferior petrosal and sigmoid dural venous sinuses in or just distal to the jugular foramen (forming the jugular bulb). It descends in t...
A useful mnemonic to remember the branches of the internal jugular vein is:
Medical Schools Let Fun People In
From inferior to superior:
M: middle thyroid vein
S: superior thyroid vein
L: lingual vein
F: facial vein
P: pharyngeal vein
I: inferior petrosal sinus
The internal palpebral arteries, or medial palpebral arteries, are branches of the ophthalmic artery, with superior and inferior medial palpebral branches arising opposite the trochlear of the superior oblique muscle.
The internal palpebral arteries enter the superior and inferio...
The internasal suture is a single, midline cranial suture between the two nasal bones. It meets the frontonasal suture to form the nasion 1.
The interscalar septum is a thin bony plate that separates each turn of the cochlea 1.
It radiates from the modiolus laterally to the spiral ligament 2. Vessels (venules, arterioles and capillaries) run within the septum through bony canals 2.
Partial absence of the intersca...
The intraconal orbital compartment or intraconal space is the conical space within the orbit and musculofascial cone, the base of which is anterior and is formed by the posterior half of the globe. The sides are formed by the extraocular muscles and their surrounding fascia which pass posteriorl...
Intraconal orbital lesions are broadly divided into two main groups; those with or without involvement of the optic nerves:
Lesions with optic nerve involvement:
optic nerve glioma
optic nerve meningioma
lymphoma and leukaemia
Intracranial dermoid cysts are uncommon lesions with characteristic imaging appearances. They can be thought of as along the spectrum: from epidermoid cysts at one end (containing only desquamated squamous epithelium) and teratomas at the other (containing essentially any kind of tissue from all...
Intraductal papilloma of salivary gland (also known as an inverted ductal papilloma or sialadenoma papilliferum) is a benign relatively rare salivary gland tumour. '
They typically arise in adulthood and there may be a slight male predilection.
They may show a characte...
Intraosseous meningioma, also referred to as primary intraosseous meningioma, is a rare subtype of meningioma that accounts for less than 1% of all osseous tumours. They fall under the subgroup of primary extradural meningiomas.
It is important to note that it has been argued by so...
The intrinsic muscles of the larynx can be considered in two groups:
muscles that control the inlet of the larynx
muscles that move the vocal ligaments
Muscles of the inlet
aryepiglottic muscle: lies within the aryepiglottic fold, runs from the side of the epiglottis and inser...
The intrinsic muscles of the tongue are a group of 4 muscular bands in the tongue. In comparison to the extrinsic muscles of the tongue, they are entirely within the tongue with no external attachments. They act to alter the shape of the tongue where as the extrinsic tongue muscles alter the pos...
Inverted papillomas are a type of Schneiderian papilloma. They are uncommon with distinctive pathological and imaging features.
The term inverted papilloma is also used to describe a urothelial lesion. For a discussion of that entity, please refer to inverted papilloma of the urin...
Iodinated contrast-induced thyrotoxicosis is rare and may occur in patients with pre-existing thyroid disease and through complications of thyrotoxicosis (e.g. cardiac arrhythmia) may be fatal. Patients with a normal thyroid gland are unaffected.
Patients with existing thyrotoxicosis should no...
Iodine123 (I123) is a radioisotope of the element iodine (atomic number 53) used in nuclear medicine imaging including to scan the thyroid gland.
Uses, dosages, and time of Imaging
routine scan: 100-400 microCi po, image at 4-6 or 24 hours
thyroid cancer scan: 1.5 mCi po, image at 4-6 or 24 ...
An isolated cleft palate is a type of facial cleft. This is a much rarer occurrence than a cleft lip +/- palate and is thought to represent a different pathological entity.
The estimated incidence is at ~1 per 2000-2500 pregnancies 4-5. There may be a slight female predilection 4....
Jaffe-Campanacci syndrome is characterised by:
multiple non-ossifying fibromas of the long bones and jaw
café au lait spots
hypogonadism or cryptorchidism
giant cell granuloma of the jaw
Jod-Basedow phenomenon is hyperthyroidism following iodine intake in a person with long term underlying thyroid disease.
Jod-Basedow phenomenon occurs due to either overactivation of the entire thyroid gland or, more commonly, autonomous nodules within the gland after iodine repletio...
The jugular foramen courses anteriorly, laterally, and inferiorly as it insinuates itself between the petrous temporal bone and the occipital bone.
The jugular foramen is usually described as being divided into two parts by a fibrous or bony septum, called the jugular spine, into...
Jugular foramen schwannomas are a rare type of intracranial schwannoma that presents as a jugular fossa mass involving the jugular foramen.
In those without neurofibromatosis type 2 (NF2), they tend to present between the 3rd to 6th decades of life. There is a recognised female pr...
The jugular fossa is a depression situated on the inferior surface of petrous temporal bone posterior to the inferior opening of carotid canal. It lodges the jugular bulb. Anteriorly, lies the jugular foramen.
glomus jugulare is the most common tumour of jugular fossa
Jugular fossa masses comprise a range of pathological lesions that arise from or extend into the jugular fossa in the skull base. Although not a common location for tumours it is not unusual for jugular fossa lesions to be discovered incidentally on cross sectional imaging.
The jugular spine is a small sharp bony ledge which separates the two parts of the jugular foramen - pars nervosa anteriorly and pars vascularis posteriorly. It is an important landmark, as masses of the jugular foramen (e.g. glomus jugulare) will erode this spine, helping distinguish them from ...
Juvenile nasopharyngeal angiofibromas (JNA) are a rare benign but locally aggressive vascular tumour.
Juvenile nasopharyngeal angiofibromas occur almost exclusively in males and usually in adolescence (~15 years). They account for only 0.5% of all head and neck tumours 2, but are ...
Staging of juvenile nasopharyngeal angiofibromas is performed with cross-sectional imaging and relies on the identification of local tumour extent, and invasion of adjacent spaces. For a discussion of this entity please refer to the parent article: juvenile nasopharyngeal angiofibroma.
Kartagener syndrome is a subset of primary ciliary dyskinesia, an autosomal recessive condition characterised by an abnormal ciliary structure or function, leading to impaired mucociliary clearance.
The prevalence of primary ciliary dyskinesia is approximately 1 in 12,000-60,000 ...
Keratosis obturans is a rare external auditory canal disease characterised by abnormal accumulation and consequently occlusion and expansion of the bony portion of the EAC by a plug of desquamated keratin. It can be confused by EAC cholesteatoma but they are completely different entities require...
The Keros classification is a method of classifying the depth of the olfactory fossa.
The ethmoid labyrinth is covered by the fovea ethmoidalis of the frontal bone and separates the ethmoidal cells from the anterior cranial fossa.
The very thin, horizontal cribriform plate (lamina cribrosa) of...
Kiesselbach's plexus (Kiesselbach's area or Little's area) is a vascular region of the anteroinferior nasal septum that comprises four arterial anastomoses:
anterior ethmoidal artery
a branch of the ophthalmic artery
a branch of the maxillary artery
greater palatine ar...
The Killian dehiscence is a triangular shaped area of weakness in the muscular wall of the pharynx, between the transverse and oblique bundles of the inferior pharyngeal constrictor 1.
It is located in the posterior wall of the laryngopharynx, slightly above the origin of the oes...
Kimura disease is a rare benign inflammatory disease that characteristically manifests as enlargement of cervical lymph nodes and salivary glands.
Kimura disease typically affects males (80%) between 20 and 40 years of age (80% of cases) 1-2, and is most frequently seen in Asia. S...
The term kissing carotids refers to tortuous and elongated vessels which touch in the midline. They can be be found in:
within the pituitary fossa
within sphenoid sinuses
within sphenoid bones
The significance of kissing carotids is two-fold:
may mimic intr...
Koerner's septum is a thin bridge of bone which divides the petrous and squamous portion of the mastoid air cells at the level of the mastoid antrum. It is commonly eroded by middle ear cholesteatomas.
Kuhn classification is an anatomical classification for the subtypes of frontal cells.
type 1 (~37%): a single air cell above the agger nasi cell
type 2 (~19%): two or more air cells above the agger nasi cell
type 3 (~7%): a single large cell above the agger nasi cell that extends into the fr...
Küttner tumour (KT) refers to a chronic sclerosing sialadenitis of the salivary glands. Despite the term tumour, it is a non neoplastic condition. It is classically described in relation the submandibular gland but less commonly can also affect other salivary glands 9 and occassionally as well ...
The labyrinthine artery, also known as the auditory artery or internal auditory artery, is a long and slender artery that is the main arterial supply to the vestibular apparatus and cochlea.
It usually originates from the AICA (~85%), although it can also branch from the basilar artery (~15%), ...
Labyrinthitis ossificans (LO), also known as labyrinthine ossification, represents pathological ossification of the membranous labyrinth as a response to an insult to the inner ear.
It is usually associated with profound sensorineural hearing loss.
It most co...
The labyrinth or lateral mass of the ethmoid bone consists of a number of thin-walled cellular cavities, the ethmoidal cells, arranged in three groups, anterior, middle, and posterior, and interposed between two vertical plates of bone; the lateral plate forms part of the orbit, the medial, part...
The lacrimal apparatus consists of the lacrimal gland and the nasolacrimal drainage apparatus.
The gland produces tears secreted into the lateral aspect of the superior fornix. The serous fluid washes over the eye and is drained at the medial canthus by the superior and inferior lacrimal canal...
The lacrimal artery is a branch of the ophthalmic artery that supplies the lacrimal gland.
The lacrimal artery travels along the upper border of the lateral rectus muscle with the lacrimal nerve to supply the lacrimal gland as well as the eyelids and conjunctiva.
The lacrimal bones are paired craniofacial bones forming anterior aspect of the medial orbital walls.
The lacrimal bones have two surfaces and four borders. The lateral orbital surface is divided by a vertical posterior lacrimal crest with an anterior fossa for lacrimal sac and ...
The lacrimal canaliculi form the first part of the nasolacrimal drainage apparatus that drains tears produced by the lacrimal gland.
There are two lacrimal canaliculi - superior and inferior on each side. They commence at the superior and inferior lacrimal puncta, which drain te...