What do you see in the following images?
Nasolabial cyst
Right nasolabial lesion with remodeling of the maxillary alveolus bone. On MRI it shows high signal intensity on both T1- and T2-weighted images with no signal suppression on the T2 FLAIR with Fat saturation sequence.
Differential Diagnosis:
Nasolabial cyst with hemorrhage
Epidermal inclusion cyst
Dermoid cyst
Dentigerous cyst
Ossification of the membranous labyrinth, high-density bone deposition involving all the cochlear turns.
This usually occurs as a complication of suppurative labyrinthitis, either due to otomastoiditis or meningitis. Other causes include trauma, autoimmune diseases, and surgery.
24-year-old male:
– Feels a lump in the upper lateral corner of right eye.
– MRI was made.
Preseptal lesion right supero-lateral corner, lateral to lacrimal gland.
T2 and T1 hyperintense, low signal after fat suppression.
No enhancement (right upper picture).
Slight remodeling of bone.
No invasive growth no post-septal component.
Diagnosis: dermoid cyst, also fits with age and location of lesion.
Left carotid sheath posterior to the carotid bulb, internal, and external carotid arteries.
Large oval avidly enhancing lesion displacing the carotid bifurcation anteriorly.
– Carotid bulb paraganglioma: avidly enhancing lesion with characteristic splaying of the internal and external carotid arteries (lyre sign).
– Glomus vagale: paragangliomas but of the vagus nerve, located posterior to the carotid arteries displacing them anteriorly.
– Vagal schwannoma: those that arises within the carotid sheath posteriorly but usually shows moderate enhancement compared with the avid enhancement of the paragangliomas.
Glomus vagale
60-year-old female:
– Since a few weeks eye movement disorder and diplopia of the left eye, tinnitus, and sinusitis.
– Non-enhanced CT of the orbits is performed (due to contrast allergy).
Widened infraorbital canal left eye with thickening of the infraorbital nerve.
Yes, we want MRI to sort things out more.
Findings: Smoothly thickened T2 hyperintense, enhancing infraorbital nerve in its canal. No continuation posteriorly to the vidian canal or anteriorly to the pre-antral region. No pathologic paranasal sinus mass or pharyngeal mucosal mass indicating perineural tumor spread.
Differential diagnosis:
Schwannoma.
Less likely malignant cause like perineural tumour spread.
Biopsy is performed of right lacrimal gland, since clinically this was found to be prominent (radiologically slight asymmetry, slightly higher T2 signal).
Histopathology: IgG4 disease or dacryoadenitis.
After this, whole body scanning showed evidence of IgG4 disease in the pancreas also. Patient was treated with steroids.
Follow-up MRI: Decrease in size of the infraorbital nerve from 11 to 5 mm. Still high T2 signal, however, the decrease in size on steroids suggests other diagnosis than schwannoma, in this case probably involved in orbital IgG4 disease. Rare!
66-year-old female:
– Feels a lump in the neck when swallowing
Mass in the right parapharyngeal space or deep part of parotid space. No parapharyngeal fat is visible, so either the lesion displaces the fat or it arises from it. It is certainly not from the carotid space, since the carotid arteries are displaced posteriorly. It is also not from the mucosal space since it compresses the lateral oropharyngeal wall, instead of arising from it.
MRI will provide you more details in head and neck lesions where the lesion arises from exactly, and what the origin is. MRI is made with T1, T2, and T1 with Gad and fat suppression.
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Origin from deep parotid lobe, so DD benign or malignant salivary gland tumor, such as pleiomorphic adenoma, adenoid cystic of mucoepidermoid cell carcinoma. Radiologists are not good in differentiating benign from malignant lesions on MRI. Histopathology has to be done. DWI will help you a little, in that, malignant lesions have often lower ADC values, but also Wharthin tumors do so. DD rare schwannoma arises from V3 (mandibular nerve) in the true parapharyngeal space.
We performed ultrasound and cytologic punction. This turned out to be a fairly rare acinic cell carcinoma.
Malignant tumors of the salivary glands are well delineated and do not have to present as ill-defined lesions, nor have to have lymph node metastasis or perineural spread
Left side of the neck.
Multiple enlarged neck clustered lymph nodes, with some of them showing necrosis.
Infectious lymphadenitis: such as TB or pyogenic lymphadenitis.
Metastasis: particularly from head and neck malignancies.
Treated lymphoma or lymphoma in immune compromised patient.
TB lymphadenitis
What do you see on the following images?
The jugular bulb bulges into the left middle ear cavity with absence of the sigmoid plate separating the jugular bulb from the middle ear in keeping with dehiscent jugular bulb.
It is one of the causes of pulsatile tinnitus, patients can also present with conductive hearing loss if the jugular vein contacts the tympanic membrane.
What do you see on this image?
There is a small lucency anterior to the vestibule, just lateral to the basal turn of the cochlea. Consistent with fenestral otosclerosis.
There are two types of otosclerosis:
1- Fenestral: is the most common type. It involves the bone anterior to the oval window and causes conductive hearing loss.
2- Retro-fenestral: involves the cochlear capsule and causes sensorineural hearing loss.
The two types can occur simultaneously.
