File Name: diagnostic ultrasound head and neck .zip
Neck masses are often seen in clinical practice, and the family physician should be able to determine the etiology of a mass using organized, efficient diagnostic methods. The first goal is to determine if the mass is malignant or benign; malignancies are more common in adult smokers older than 40 years.
If the history and physical examination do not find an obvious cause, imaging and surgical tools are helpful. Contrast-enhanced computed tomography is the initial diagnostic test of choice in adults. Computed tomography angiography is recommended over magnetic resonance angiography for the evaluation of pulsatile neck masses. If imaging rules out involvement of underlying vital structures, a fine-needle aspiration biopsy can be performed, providing diagnostic information via cytology, Gram stain, and bacterial and acid-fast bacilli cultures.
The primary concern in adults with a persistent neck mass is malignancy. Fortunately, a history and physical examination coupled with an organized diagnostic evaluation typically reveal a definitive diagnosis. When the etiology is elusive, a head and neck surgeon should be consulted. A persistent neck mass in an adult older than 40 years should prompt a search for a malignant source. Contrast-enhanced computed tomography is the initial diagnostic test of choice in an adult with a persistent neck mass.
Fine-needle aspiration biopsy is an effective tool to determine the etiology of a neck mass. Neck anatomy is divided into triangles with the sternocleidomastoid being the central component of each division. The anterior and posterior cervical triangles share a common border with the sternocleidomastoid. The common pattern of lymphatic drainage is helpful in diagnosing metastases from various organs Figure 1.
Cervical triangle anatomy with common lymph node locations and drainage areas. A clinically relevant approach to differentiating neck masses depends on whether the mass is acute, subacute, or chronic Tables 1 and 2. Squamous cell carcinoma of the upper aerodigestive tract. Acute sialadenitis. Rapid or gradual onset of pain and swelling; local edema, erythema, tenderness, or fluctuance consistent with an abscess.
Bartonella henselae infection. Epstein-Barr virus infection. HIV infection. Mycobacterium tuberculosis extrapulmonary. Purified protein derivative test to rule out atypical mycobacteria infection; acid-fast bacilli culture. Antibiotics: rifampin and isoniazid; add pyrazinamide and ethambutol or streptomycin in endemic areas; refer to a head and neck surgeon if persistent after initial diagnosis and treatment.
Staphylococcal or streptococcal infection. Viral URI. Hodgkin lymphoma. Human papillomavirus—related squamous cell carcinoma. Rapidly enlarging, lateral, cystic lymph nodes; persistent cervical nodal hypertrophy; palatine or lingual tonsillar asymmetry; dysphagia; voice changes; pharyngeal bleeding. Metastatic cancer. Non-Hodgkin lymphoma. Painless, rapidly growing lymph node; rubbery, soft, mobile; may involve the tonsillar ring in the pharynx.
Parotid tumors. Slow-growing, unilateral, mobile, asymptomatic; cranial nerve often VII [facial] involved if malignant. Upper aerodigestive tract squamous cell carcinoma. Nonhealing ulcers, dysarthria, dysphagia, odynophagia, loose or misaligned teeth, globus, hoarseness, hemoptysis, oropharyngeal paresthesias. Castleman disease angiofollicular lymphoproliferative disease. Kikuchi disease histiocytic necrotizing lymphadenitis.
Kimura disease. Submandibular triangle, orbital, epicranial, periauricular; nontender, ill-defined. Rosai-Dorfman disease. Carotid body tumors. Flushing, palpitations, hypertension if hormonally active, dysphagia, dyspnea, eustachian tube dysfunction.
Painless oropharyngeal or upper anterior triangle of the neck; pulsatile, compressible with a bruit or thrill, mobile from medial to lateral direction. Branchial cleft cyst. Often diagnosed as a child; slow or rapidly growing after URI; acute or subacute. Dermoid cyst. Thyroglossal duct cyst. Often diagnosed in childhood; slow growing or may arise quickly after URI; may present as acute or subacute.
Similar to carotid body tumors; ipsilateral tonsil may pulsate and be deviated to midline. Graves disease. Radioactive iodine ablation, thyroidectomy, methimazole Tapazole or propylthiouracil. Hashimoto thyroiditis. Iodine deficiency. Lithium use. Monitor thyroid function at 6 to 12 months, treat dysfunction, discontinuation not required. Toxic multinodular. Midline, superior to thyroid cartilage; resonant, intermittent, globus sensation. Cold thyroid nodule. Thyroid cancer.
Toxic thyroid adenoma. Neck masses that appear over a short period are generally symptomatic. Blunt or sharp trauma may damage tissue and vasculature, creating a hematoma.
Small hematomas are typically self-limited, but large, rapidly expanding hematomas require immediate intervention and possible surgical exploration. Similar mechanisms of trauma, plus the addition of shearing forces, potentiate the formation of pseudoaneurysms or arteriovenous fistulas characterized by soft, pulsatile masses with a thrill or bruit. Computed tomography CT angiography delineates the extent of any possible vascular injury, and treatment is usually surgical ligation.
By far, the most common cause of cervical lymphadenopathy is infection or inflammation created by an array of odontogenic, salivary, viral, and bacterial etiologies.
These lymph nodes are often swollen, tender, and mobile, and can be erythematous and warm. Upper respiratory symptoms caused by common viruses usually last for one to two weeks, whereas lymphadenopathy generally subsides within three to six weeks after symptom resolution.
Bacterial infections of the head and neck predominantly cause cervical lymphadenopathy. Lymphadenopathy caused by Staphylococcus aureus or group A beta Streptococcus has no predictable sites of lymph node inflammation. Bartonella henselae infection causes mobile, fluctuant, erythematous, and tender, but characteristically isolated, lymph nodes similar to lymphadenopathy caused by staphylococcal and streptococcal infections. Cat-scratch disease develops when a kitten or flea transmits B.
The extrapulmonary form of Mycobacterium tuberculosis infection causes a cervical lymphadenopathy. A negative result on purified protein derivative testing does not rule out atypical mycobacterial infections, which also should be considered. A fine-needle aspiration biopsy FNAB of the lymph nodes or referral to a head and neck surgeon may be warranted if the lymphadenopathy persists after initial diagnosis and treatment.
Inflammation of salivary glands acute sialadenitis commonly occurs in older, debilitated persons in the setting of dehydration or recent dental procedures. Bimanual compression toward the duct opening may expel purulent discharge into the oral cavity. Neck CT with intravenous contrast media may be warranted to confirm this diagnosis and rule out other contributing etiologies such as a dental abscess or local tumor compression.
Subacute masses are noticed within weeks to months. Although these masses might grow somewhat quickly, they often go unnoticed at onset because of their asymptomatic nature. A persistent asymptomatic neck mass in an adult should be considered malignant until proven otherwise. Squamous cell carcinomas of the upper aerodigestive tract are the most common primary neoplasms of the head and neck, and their metastases are often the source of cervical lymphadenopathy of unknown origin.
However, any persistent cervical lymphadenopathy or symptoms in the setting of risk factors, nonresponse to antibiotics, or unclear etiology warrants further investigation. A subset of squamous cell carcinomas with increasing prevalence includes those related to human papillomavirus infection especially high-risk human papillomavirus Excisional biopsy is the preferred diagnostic approach for these tumors following review of contrast-enhanced CT or FNAB results.
Skin cancers, especially melanoma, also metastasize to local lymph nodes. When a primary head and neck cancer is not evident to explain regional lymphadenopathy, physicians should search mucosal areas nose, paranasal sinuses, oral cavity, and nasopharynx for melanoma.
When metastases manifest as supraclavicular lymphadenopathy, FNAB reveals a malignancy in more than one-half of cases, with age older than 40 years being the major predictor of malignancy.
The neck is a common area for lymphoma to present as a painless lymph node that may grow rapidly, and subsequently become painful. Early constitutional symptoms often precede development of diffuse lymphadenopathy and splenomegaly. In comparison to lymph nodes associated with metastatic disease characterized above, those associated with lymphoma are usually rubbery, soft, and mobile. Congenital masses are more common in childhood but can grow slowly, persisting into adulthood.
Thyroglossal duct cysts, the most common congenital cyst, are midline, adjacent to the hyoid bone, and rise with deglutition.
Dermoid cysts, typically located in the submental triangle, are soft, doughy, painless masses that enlarge with entrapment of epithelium in deeper tissue and are less prevalent than thyroglossal or branchial cleft cysts.
Thyroid pathology accounts for most chronic anterior neck masses, and these masses are often insidious. A diffusely enlarged thyroid gland may be due to Graves disease, Hashimoto thyroiditis, or iodine deficiency, but can be caused by goitrogenic exposures such as lithium.
Arch Otolaryngol Head Neck Surg. Owing to its limited anatomical depiction, it cannot as yet replace other diagnostic procedures in preoperative planning but does contribute valuable complementary diagnostic information. Computed tomograpy may have difficulties in identifying recurrent carcinomas. For routine diagnosis of nodal spread in the neck, CCDS is recommended. Panendoscopy is a valuable diagnostic procedure that can provide key information in cases of superficial mucosal tumor involvement.
In the past, head-and-neck ultrasound examinations were mostly performed by radiologists, whereas ultrasound examinations of the thyroid gland were mostly carried out by endocrinologists and endocrine surgeons. However, in recent years, promotion by various medical centers has resulted in more and more otolaryngologists joining the ranks of head-and-neck ultrasound examinations, resulting in ultrasound examinations becoming a routine examination item in otolaryngology. Since , due to promotion by Professor Pa-Chun Wang, medical staffs from Cathay General Hospital were successively sent to National Taiwan University Hospital to learn from the pioneer of head-and-neck ultrasound in Taiwan: Professor Cheng-Ping Wang on the operation techniques and diagnostic methods for head-and-neck ultrasound. Until now, there are 5—6 attending staffs performing head-and-neck ultrasound at our department in Cathay General Hospital. Under the support of the current department chair, Dr. Ultrasonography is mainly used for head-and-neck mass evaluation and cancer survey.
There is also the possibility of accepting book reviews of recent publications related to General and Digestive Surgery. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published. Read more. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.
Download instantly Diagnostic Ultrasound - Head and Neck by Anil T. Ahuja. It is ebook in PDF format.
Metrics details. The reliability of musculoskeletal diagnostic ultrasound imaging MSK-DUSI for the evaluation of neck musculature has been sparsely documented in the research literature. Until now, research has featured a limited number of subjects and only few studies have tested for both inter- and intra-reliability using appropriate methodology. Four examiners conducted an inter- and intra-rater reliability and agreement study. Fifty females with and without neck pain NP between the ages of 20—70 were recruited from October to April
Purchase Diagnostic Ultrasound: Head and Neck - 1st Edition. Print Book & E-Book. ISBN ,Reply