Abscesses are focal confined collections of suppurative inflammatory material and can be thought of as having three components 1:
a central core consisting of necrotic inflammatory cells and local tissue
peripheral halo of viable neutrophils
surrounded by a 'capsule' with dilated blood vessel...
Acute sinusitis is an acute inflammation of the paranasal sinus mucosa that lasts less than four weeks and can occur in any of the paranasal sinuses. If the nasal cavity mucosa is also involved then the term rhinosinusitis may be used.
Fever, headache, postnasal discharge...
Cervical lymphadenopathy in an adult can result from a vast number of conditions. They include:
from head and neck tumours
other neoplastic lesions
Amaurosis fugax is the transient mono-ocular loss of vision, normally lasting a few seconds to a few minutes, and is secondary to vascular ischaemia/insufficiency. Usually the cause is ascribed to occlusion of the central retinal artery there are a wide number of local and central causes.
The atlantodental interval (ADI), as the name suggests, is the horizontal distance between the anterior arch of the atlas and the dens of the axis, used in the diagnosis of atlanto-occipital dissociation injuries and injuries of the atlas and axis.
It is the distance (in mm) between the posteri...
Autoimmune thyroiditises (AIT) refers to a group of conditions where there is inflammation involving the thyroid gland related to thyroid antibodies.
They are most common thyroid disease group in the paediatric population 5.
Entities that fall under this category inclu...
The basion-axial interval (BAI), as the name suggests, is the horizontal distance between the basion and the posterior cortex of the axis, used in the diagnosis of atlanto-occipital dissociation injuries.
It is the distance (in mm) between the basion and the superior extension of the posterior ...
The basion-dens interval (BDI), as the name suggests, is the distance between the basion and the tip of the dens, used in the diagnosis of atlanto-occipital dissociation injuries.
It is the distance from the most inferior portion of the basion to the closest point of the superior aspect of the ...
There are a number of benign metastasising tumours:
benign metastasising meningioma 1,2
benign metastasising leiomyoma 3
primary adenoma of thyroid 4
giant cell tumour of bone 5
Benign minor salivary gland pathology is a broad term that encompasses a number of relatively uncommon pathologies that affect the minor salivary glands of the head and neck:
salivary retention cysts
Bilateral thinning of the parietal bones, also known as biparietal osteodystrophy, is an uncommon, slowly progressive acquired disease of middle-aged people with slight female predilection. It is typically an incidental finding.
The aetiology is unknown but is thought to be an age-r...
The bimastoid line has been described and used to evaluate basilar invagination on frontal skull plain film and coronal reconstructed CT image.
The bimastoid line is drawn between the inferior tips of the of mastoid processes bilaterally. The tip of the odontoid process of C2 normally projects ...
Blunt traumatic neck injury is uncommon because it is usually protected by the head, shoulders, and chest. This term is generally used to refer to injuries of the neck besides to cervical spine injuries, which are common.
Blunt injury to the neck is most commonly from motor vehicle ...
Boogard's angle is measured by drawing a line from basion to opisthion and another line along the plane of the clivus to the basion intersecting the first line - the angle between these two lines is measured .
The normal angle is 126° +/- 6°. If the angle measures more than 136° it is indicativ...
Calcification of the external ear (auricular cartilage) may arise from a number of causes, including:
gout and pseudogout
Calcification of the globe has many causes, varying from the benign to malignant. When calcification is seen of the posterior half of the globe, it could relate to any of the layers (scleral, choroidal or retinal), as it is not possible to separate them out on CT.
drusen: 1% population...
Serum carcinoembryonic antigen (CEA) is a cell-adhesive glycoprotein that was discovered in colorectal cancer in 1965, and is hence one of the oldest and most used tumour markers. Its name derives from its normal expression in fetoembryonic liver, gut and pancreas tissue.
Normal range of CEA is...
Chamberlain line is a line joining the back of hard palate with the opisthion on a lateral view of the craniocervical junction.
It helps to recognise basilar invagination which is said to be present if the tip of the dens is >3 mm above this line.
McGregor developed a modificatio...
Cleft palate is a type of facial cleft. It can occur in two main aetiologically different forms:
in association with a cleft lip: cleft lip +/- palate (much commoner)
on its own: isolated cleft palate (rarer)
The differential of a mass involving or arising from the clivus is a relatively narrow one and can be divided into whether the lesion arises from the skull base itself, from the intracranial compartment or from below the base of skull.
When evaluating the clivus it is important to compare the...
Cochlear implants (CI) are a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. Unlike conventional hearing aids, the cochlear implant does not amplify sound, but works by directly stimulating any functioning audi...
COL4A1-related disorders are a group of autosomal dominant disorders caused by a mutation in the COL4A1 gene.
The exact prevalence is unknown, but the group of disorders is considered to be under-recognised, especially asymptomatic variants 1.
The clinical ...
Conductive hearing loss is caused by a range of developmental, congenital or acquired pathology to the external, middle or inner ear.
Essentially any process that obstructs or disrupts the passage of sound waves through the outer or middle ear can cause conductive hearing loss and th...
Congenital calvarial defects are a group of disorders characterised by congenital calvarial bone defects that vary in severity.
CT with 3D shaded surface reformats is the best imaging tool as it demonstrates calvarial defects and bone margins:
Convexal subarachnoid haemorrhages (cSAH) are nontraumatic intracranial haemorrhages that occur within the surface sulci of the brain (c.f. basal cisternal distribution of aneurysmal SAH). There are various causes of convexal SAH, some of which include:
dural venous sinus thromboses
Craniotomy is a surgical procedure where a piece of calvarial bone is removed to allow intracranial exposure. The bone flap is replaced at the end of the procedure, usually secured with microplates and screws. If the bone flap is not replaced it is either a craniectomy or cranioplasty.
CSF otorrhoea is defined as leakage of cerebrospinal fluid (CSF) from the subarachnoid space into the middle ear cavity or mastoid air cells.
There are a number of underlying causes, and thus no specific demographic is affected.
Patients typically present ...
The differential diagnosis of a cystic mass adjacent to the angle of mandible includes:
2nd branchial cleft cyst
lymphatic malformation (lymphangioma)
from metastatic squamous cell carcinoma
from metastatic papillary thyroid cancer
Cystic or necrotic appearing lymph nodes can be caused by a number of infectious, inflammatory or malignant conditions:
squamous cell carcinoma metastases
plasmacytoid T-cell leukemia
acute myeloid leukemia
herpes simplex lymphadenit...
The differential for cystic parotid lesions includes:
bilateral cystic parotid lesions
benign lymphoepithelial lesions of HIV
unilateral cystic parotid lesion(s)
first branchial cleft cyst: parotid lymphoepithelial cy...
Dental (periapical) abscess is an acute infection of the periapical tissue around the root of the tooth.
Patients may present with pain, oedema, and purulent discharge localised to the site of pathology with or without fever and tender cervical lymphadenopathy 1.
Differential diagnosis for calcified masses in the mandible includes:
calcifying odontogenic cyst (Gorlin cyst)
calcifying epithelial odontogenic tumour (Pindborg tumour)
Dysphagia refers to subjective awareness of difficulty or obstruction during swallowing. It is a relatively common and increasingly prevalent clinical problem.
Fluoroscopy is the mainstay of imaging assessment but manometry can help evaluate the esophageal motor pattern and lower esophageal sp...
Ectopia lentis refers to subluxation or dislocation of the lens of the eye secondary to dysfunction or disruption of zonular fibres.
systemic and syndromic disorders
typically upwards and out
most common spontaneous cause 2
homocystinuria - ty...
Endophthalmitis is a potentially sight-threatening condition that involves intraocular inflammation of any cause. It is either infectious or noninfectious in aetiology, but in clinical practice, intraocular infections are the commonest.
Eye pain and discomfort are common...
There is a short list of causes for enlarged extraocular muscles:
thyroid associated orbitopathy
amyloidosis (very rare) 2
Extraconal orbital lesions include lesions which arise from structures within the extraconal orbital space and those extending from adjacent structures into the orbits.
dermoid cyst: most common lesion in paediatrics
lacrimial gland lesions
Facial fractures are commonly caused by blunt or penetrating trauma sustained during motor vehicle accidents, assaults, and falls. The facial bones are thin and relatively fragile making them susceptible to injury.
Males are affected more commonly than females and facial fractures...
Facial palsy refers to the neurological syndrome of facial paralysis. It can result from a broad range of physiological insults to the facial nerve or its central nervous system origins. The most common causes of this is Bell palsy.
While facial palsy refers to the clinical presen...
Focal calvarial thinning can result from a number of causes. They include:
bilateral thinning of the parietal bones (normal variant) most common
mega cisterna magna
peripherally located tumors (e.g. oligodendroglioma)
Frontal bossing is a calvarial radiographic feature where the front of the skull appears protruding anteriorly. It is best appreciated on a sagittal or lateral image.
This feature can be seen in many conditions (in alphabetical order):
Heterogeneous echogenicity of the thyroid gland is a non-specific finding and is associated with conditions diffusely affecting the thyroid gland. These include:
High arched palates are a facial feature of many syndromes, although the classic association is Marfan syndrome. There are hundreds of conditions associated with high arched palates, with some of the radiologically-more important including:
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...
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
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...
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...
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 ...
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
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.
Lacrimal gland masses can be classified into two broad groups - inflammatory (~50%) and neoplastic, either lymphoma (25%) or salivary gland type tumours (~25%).
affects ~25% of patients with systemic disease
orbital inflammatory pseudotumour
Laryngeal cysts can occur in any part of larynx, but are more frequent in supraglottic locations, such as the epiglottis and vallecula. The prevalence of each location varies on different studies.
The laryngeal cysts represent a rare group, about 5%, of benign laryngeal lesions 1...
Leukocoria (also spelled as leucocoria or leukokoria) refers to an abnormal white reflection from the retina of the eye. Despite its colour, the reflection is related to the familiar red-eye effect. Usually, when a light is shone through the iris, the retina appears red to the observer. In leuko...
Longitudinal temporal bone fractures are petrous temporal bone fractures that occur parallel to the long axis of the petrous temporal bone. Although more current classifications of the extent of temporal bone fractures focus on the integrity of the otic capsule rather than the fracture orientati...
The increased globe size or macrophthalmia may have many differentials:
buphthalmos (congenital glaucoma)
macrophthalmus in neurofibromatosis type 1 (NF1)
connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome
Mandibular lesions are myriad and common. The presence of teeth results in lesions that are specific to the mandible (and maxilla) and a useful classification that defines them as odontogenic or non-odontogenic. While it may often not be possible to make a diagnosis on imaging alone, this classi...
There are many causes for mandibular periostitis:
Langerhans cell histiocytosis
malignancy (both primary and metastatic)
necrosis, e.g. radiation osteonecrosis
Garre's sclerosing osteomyelitis
McRae line is a radiographic line drawn on a lateral skull radiograph or midsagittal section of CT or MRI, joining the basion and opisthion.
Normal position of the tip of dens is 5mm below this line. If the tip of the dens migrates above this line it indicates the presence of basilar invaginati...
Medical devices in the neck are regularly observed by radiologists on plain film and CT reporting. They include devices which pass through the neck onto the chest and stomach.
Vascular access devices
peripherally inserted central catheters (PICC)
central venous catheters
There are a range of middle ear tumours, which are more likely to be benign than malignant.
The three most common middle ear tumours are (not in any particular order as there are differences in the literature) 1-3:
glomus tympanicum paraganglioma
Midline neck masses have a relatively narrow differential, as few structures are present in the midline. Dividing the causes according to structure of origin is a useful schema.
lymph node(s): Delphian node(s)
thyroglossal duct cyst
A mucocele simply refers to accumulation and expansion of a structure by mucus. It occurs in a variety of locations which are discussed separately:
paranasal sinus mucocele
oral cavity e.g. ranula, mucous retention cysts
mucocele of the appendix 1
mucocele of the gallbladder
mucocele of the...
The differential diagnosis for multiple cystic neck lesions is different to that for a solitary cystic neck mass.
Cystic neck lesions are seen in:
necrotic metastatic SCC nodes: older patient, M>F
papillary thyroid carcinoma metastases: usually a younger patient, F>M
Multiple endocrine neoplasia (MEN) syndromes are a collection of syndromes characterised by the presence of, as the name would suggest, multiple endocrine tumours. They are autosomal dominant in inheritance.
MEN1 (Wermer syndrome)
MEN2 (multiple endocrine adenomatosis)
MEN2a (Sipple syndrome)...
Obstruction of nasolacrimal drainage apparatus results in epiphora and can be primary or secondary, congenital or acquired. Obstruction can occur in canaliculi, lacrimal sac, or nasolacrimal duct (post saccular) levels.
Congenital obstruction is usually secondary to persistence of the membrane ...
Ocular metastases, also termed uveal metastases, account for over 80% of all ocular pathology, and need to be distinguished from extraocular metastasis, which are a quite different group of tumours.
This article will discuss metastatic lesions affecting the orbits. For other intracranial metast...
Ocular pathology covers a wide range of conditions and therefore represents the cause of a wide range of symptoms, signs and radiographic features.
Ocular metastases account for over 80% of all ocular pathology. With regard to the remainder of ocular lesions, the primary differentiating factor ...
Odontohypophosphatasia is the mildest form of hypophosphatasia that manifests as tooth dysplasia and/or early loss of deciduous or permanent teeth.
As with all forms of hypophosphatasia, the underlying abnormality is a mutation in the ALPL gene that encodes for tissue non-specific al...
Ophthalmoplegia describes the abnormal eye movement that occurs because of paralysis of one or more of the six extraocular muscles involved in eye movements. Classification can be based on the cause of the ophthalmoplegia or the directions of the affected movements.
There are numerous causes of...
Enlargement of the optic nerves is uncommon and has a surprisingly broad differential:
optic nerve glioma
optic nerve meningioma
Several cystic and cyst-like orbital lesions may be encountered in imaging of the orbits:
developmental orbital cysts
dermoid: commonest benign orbital tumour in childhood
congenital cystic eye
Orbital infection is a relatively commonly encountered pathology.
It comprises of three main clinical entities with the most important distinction between that of orbital and periorbital cellulitis:
periorbital cellulitis (preseptal cellulitis) is limited to the soft tissues anterior to the or...
The differential diagnosis of orbital inflammatory diseases (including orbital pseudotumours) can be divided based on their location into:
dacryoadenitis of lacrimal glands
myositis of extraocular muscles
perineuritis of optic nerve
An orbital mass carries a relatively wide differential:
lacrimal gland or duct tumours
rhabdomyosarcoma of the orbit
optic nerve meningioma
optic nerve glioma
optic nerve schwannoma
developmental orbital cysts 3:
Orbital vascular lesions may be difficult to distinguish on imaging. However, the following conditions have been described:
lymphangioma / lymphangiovenous malformation / venolymphatic malformation
orbital venous malform...
Otitis media refers to inflammation or infection of the middle ear cavity. It is commonly seen in children and is termed otomastoiditis when inflammation spreads to involve the mastoid.
Common complaints include otalgia, otorrhoea, headache, fever, and systemic upset. In ...
Oxalosis results in supersaturation of calcium oxalate in the urine (hyperoxaluria), which in turn results in nephrolithiasis and cortical nephrocalcinosis.
This article focus on the secondary oxalosis, please refer to primary oxalosis for a specific discussion on this entity.
The differential diagnosis of paediatric cervical lesions is commonly encountered in practice, unfortunately, the list is long.
Most lesions tend to be inflammatory 3:
infected branchial cle...
Parotid enlargement has a wide differential given the significant breadth of pathology that can affect the parotid gland. These can be separated by the standard surgical sieve approach into infective, inflammatory, immune, neoplastic, infiltrative and congenital causes.
A pedunculated intratracheal mass has a variety of differential diagnoses:
benign tumour, e.g. hamartoma, chrondroma, lipoma
metastasis to tracheal mucosa, e.g. renal cell carcinoma, melanoma
polyp, e.g. inflammatory, antrochoanal
Penetrating traumatic neck injury can be a potentially devastating injury due to the high density of crucial anatomical structures within the neck.
Young males are highly represented in patients with a traumatic neck injury. In one study, 11:1 ratio of males to females were ident...
There is a wide differential diagnosis of petrous apex lesions:
petrous apex cephalocoele 4
cholesterol granuloma: most common cystic appearing lesion 3
mucocoele of petrous apex 2
Pneumoparotid refers to air in the parotid gland and can cause unilateral/bilateral parotid swelling. In severe cases it can be associated with subcutaneous emphysema.
Any profession or recreation that increases oral positive pressure can cause air to reflux up the parotid ducts int...
Powers ratio is a measurement of the relationship of the foramen magnum to the atlas, used in the diagnosis of atlanto-occipital dissociation injuries.
The ratio, AB/CD, is measured as the ratio of the distance in the median (midsagittal) plane between the:
basion (A) and the posterior spinola...
There are a number of primary malignancies of the nasopharynx:
nasopharyngeal carcinoma (squamous cell carcinoma): 70%
lymphoma (sinonasal lymphoma): 20%
adenoid cystic carcinoma
Proptosis refers to forward protrusion of the globe with respect to the orbit. There are many causes of proptosis which can be divided according to location and it is worth remembering that it is not just orbital disease processes that cause proptosis.
Exophthalmos also describes f...
Pulsatile exophthalmos or pulsatile proptosis is a clinical symptom characterized by protrusion and pulsation of the eyeball that can occur due to various causes:
neurofibromatosis type 1 (with sphenoid wing dysplasia)
trauma (orbital roo...
Ranawat's line is the perpendicular distance between the centre of the sclerotic ring of C2 and a line drawn along the axis of the C1 vertebra.
Normal value is 17 mm in males and 15 mm in females. It is decreased in basilar invagination.
History and etymology
Chitranjan S Ranawat is an Americ...
RASopathies are a class of developmental disorders caused by germline mutations in genes that encode for components or regulators of the Ras/mitogen activated protein kinase (MAPK) pathway.
As a group, RASopathies represent one of the most common malformation syndromes, with an in...
Radiological manifestations of recreational drug use are not infrequently seen as the use of recreational drugs is widespread.
Interestingly, recent reports have suggested a decreasing incidence of reported drug use in the general population over the past decade, but it remains th...
Salivary gland tumours are variable in location, origin, and malignant potential.
In general, the ratio of benign to malignant tumours is proportional to the gland size; i.e. the parotid gland tends to have benign neoplasms, the submandibular gland 50:50, and the sublingual glands a...
Head and neck manifestations of sarcoidosis can have three main forms:
orbital involvement: orbital sarcoidosis
parotid gland involvement
nodal involvement: cervical lymphadenopathy in sarcoidosis