Imaging features and surgical management of giant parathyroid adenoma with autoinfarction

Autoinfarction of a parathyroid adenoma can have an atypical clinicoradiologic features that can mimic an inflammatory process or malignancy. In addition, the associated fibrosis makes surgical resection more challenging than for regular parathyroid adenomas. The implications of these findings are that while autoinfarction of parathyroid adenomas is a rare phenomenon, this entity should be considered when there are heterogeneous and cystic components on imaging in patients without hypercalcemia. Ultimately, histopathology is necessary for definitive diagnosis.

CT Findings of Firework Injuries to the Head and Neck

OBJECTIVES

The purpose of this study is to review the CT imaging findings of injuries in the head and neck caused by fireworks through a case series.

METHODS

The imaging database from the University of Chicago Medicine was searched with "fireworks," "firecrackers," and "mortar" as keywords and CT as the imaging modality. Cases without acute CT findings or initial CT scans were excluded.

RESULTS

Eighteen cases with acute CT findings of head and neck firework injuries were identified and included. The associated injuries included skull fractures (5, 28%), ocular injuries (7, 39%), soft tissue trauma (18, 100%), retained foreign bodies (8, 44%), and intracranial trauma (2, 11%).

CONCLUSIONS

Fireworks can cause injuries of varying severity in the head and neck, including blunt and penetrating trauma, that warrant CT evaluation.

A preliminary diagnostic accuracy study of quantitative MRI biomarkers for differentiating parotid tumor types

Background

Differentiating among the different types of parotid tumors on imaging is useful for guiding clinical disposition, which ultimately may lead to surgical management. The goal of this study was to determine whether quantitative T2 signal characteristics and morphologic features on magnetic resonance imaging (MRI) can serve as predictive biomarkers for distinguishing between tumor types.

Methods

A retrospective review of T2-weighted MRIs in patients with pathology-proven parotid tumors was performed. Quantitative T2 maps and surface regularity measurements of the tumors were obtained via semi-automated regions of interest (ROI). Linear Discriminant Analysis was used to populate the receiver operating characteristics (ROCs) curves for these variables. A P value of <0.05 was considered to be significant.

Results

A total of 35 tumors (21 benign and 14 malignant neoplasms) were included in this analysis. For differentiating the benign versus malignant classes of parotid tumors, T2 signal and surface regularity combined yielded an area under the curve of 0.62 (P value: 0.2) through the ROC analysis. However, for the pleomorphic adenomas versus other types of parotid tumors, using both T2 signal and surface regularity yielded an area under the curve of 0.81 (P value: 0.007) through the ROC analysis.

Conclusions

T2 signal and surface regularity combined can significantly differentiate pleomorphic adenomas from other types of parotid tumors and can potentially be used as a predictive imaging biomarker.

Imaging Features of Intratumoral Injection of NBTXR3 for Head and Neck Squamous Cell Carcinoma Lymph Node Metastases

NBTXR3 nanoparticle injection is a relatively novel radioenhancer for treatment of various cancers. CT scans following NBTXR3 injection of metastatic lymph nodes from head and neck squamous cell carcinoma were reviewed in a small series of patients. The radioenhancing appears as hyperattenuating, with a mean attenuation of the injected material of 1516 HU. The material was found to leak beyond the margins of the tumor in some cases.

MR imaging of Nasal and Paranasal Sinus Malignant Neoplasms

MRI is useful for evaluating sinonasal malignancies. In particular, MRI can provide important information pertinent to treatment planning, such as delineating the presence of intracranial and orbital extension. This article reviews the MRI protocols, staging, imaging features, and differential diagnosis related to malignant nasal and paranasal sinus neoplasms.

Impact of the COVID-19 pandemic on neuroimaging scan volumes at a teaching hospital

BACKGROUND

The COVID-19 pandemic led to a widespread socioeconomic shutdown, including medical facilities in many parts of the world. The purpose of this study was to assess the impact on neuroimaging utilisation at an academic medical centre in the United States caused by this shutdown.

METHODS

Exam volumes from 1 February 2020 to 11 August 2020 were calculated based on patient location, including outpatient, inpatient and emergency, as well as modality type, including computed tomography and magnetic resonance imaging. 13 March 2020 was designated as the beginning of the shutdown period for the radiology department and 1 May 2020 was designated as the reopening date. The scan volumes during the pre-shutdown, shutdown and post-shutdown periods were compared using t-tests.

RESULTS

Overall, neuroimaging scan volumes declined significantly by 41% during the shutdown period and returned to 98% of the pre-shutdown period levels after the shutdown, with an estimated 3231 missed scans. Outpatient scan volumes were more greatly affected than inpatient scan volumes, while emergency scan volumes declined the least during the shutdown. In addition, the magnetic resonance imaging scan volumes declined to a greater degree than the computed tomography scan volumes during the shutdown.

CONCLUSION

The shutdown from the COVID-19 pandemic had a substantial but transient impact on neuroimaging utilisation overall, with variable magnitude depending on patient location and modality type.

Effect of an iterative reconstruction quantum noise reduction technique on computed tomography radiomic features

Purpose: The goal of this study was to quantify the effects of iterative reconstruction on radiomics features of normal anatomic structures on head and neck computed tomography (CT) scans. Methods: Regions of interest (ROI) containing five different tissue types and an ROI containing only air were extracted from CT scans of the head and neck from 108 patients. Each scan was reconstructed using three different iDose 4 reconstruction levels (2, 4, and 6) in addition to bone, thin slice (1-mm slice thickness), and thin-bone reconstructions. From each ROI in all reconstructions, 142 radiomic features were calculated. For each of the six ROIs, features were compared between combinations of iDose levels (2v4, 4v6, and 2v6) with a threshold of α = 0.05 after correcting for multiple comparisons ( p < 0.00006 ). Features from iDose 4 - 2 reconstructions were also compared to bone, thin slice, and thin-bone reconstructions. Spearman's rank correlation coefficient, ρ , quantified the relative feature value agreement across iDose 4 reconstructions. Results: When comparing radiomics features across the three iDose 4 reconstruction levels, over half of all features reflected significant differences for all tissue types, while no features demonstrated significant differences when extracted from air ROIs. When assessing feature value agreement, at least 97% of features reflected excellent agreement ( ρ > 0.9 ) when comparing the three iDose levels for all ROIs. When comparing iDose 4 - 2 to bone, thin slice, and thin-bone reconstructions, more than half of all features demonstrated significant differences for all ROIs and 89 % of features reflected excellent agreement for all ROIs. Conclusion: Many radiomics features are dependent on the iterative reconstruction level, and the magnitude of this dependency is affected by the tissue from which features are extracted. For studies using images reconstructed using varying iDose 4 reconstruction levels, features robust to these should be used.

Squamous Cell Carcinoma Arising from Sinonasal Inverted Papilloma

Sinonasal inverted papillomas occasionally undergo malignant transformation into squamous cell carcinoma, which can be associated with EGFR mutations. Since biopsy can potentially under-sample the tumor, CT and MRI can provide clues as to the presence of malignant transformation. In particular, this entity tends to appear different from benign inverted papilloma on imaging, including prominent bone erosions, necrosis, low diffusivity in the solid tumor components, and absence of the cerebriform pattern on MRI. The radiology findings, pathology features, and management of squamous cell carcinoma arising from inverted papilloma are described.

Magnetic resonance imaging (MRI) features of cataracts in pediatric and young adult patients

Background

The goal of this study is to systematically evaluate the magnetic resonance imaging (MRI) signal characteristics and size of cataracts that may be encountered in pediatric and young adult patients.

Methods

A retrospective analysis of the MRI features with cataracts in a series of cases, including characterization of signal intensity on T2-weighted and T1-weighted sequences, as well as measuring the thickness of the lens.

Results

Among nine cataracts in seven patients, three lenses were thickened and hyperintense on T2-weighted sequences, presumably related to osmotic effects. The rest of the lenses were either normal in size and signal characteristics, such as in the cases of neurofibromatosis type 2 or small in cases of microphthalmos, with signal characteristics related to calcifications.

Conclusions

There are several different types of cataracts that can occur in pediatric and young adult patients, which may or may not be conspicuous on MRI. The findings in this study can serve as a guide for what abnormalities of the lens may be encountered on MRI.

High-Resolution MRI Microscopy Coil Assessment of Parotid Masses

The goal of this study was to determine whether high-resolution magnetic resonance imaging (MRI) microscopy coil imaging can improve the depiction parotid masses. A total of 14 parotid masses, including 7 salivary neoplasms, 2 abnormal lymph nodes, and 5 benign cystic lesions were imaged with T2-weighted and fat-suppressed postcontrast T1-weighted sequences using a 47-mm diameter microscopy coil in addition to conventional MRI sequences acquired with a conventional head and neck neurovascular coil. Compared to conventional parotid MRI sequences, microscopy coil images provided better definition of the margins of neoplasms, provide more detailed definition of lymph node morphology, and better depict certain cyst contents in the superficial portions of the parotid gland. The microscopy coil images provided significantly better definition of lesions and surrounding tissues within the superficial parotid gland with resptect to the deep parotid gland structures due to loss of signal. Furthermore, the fat-suppressed postcontrast T1-weighted microscopy coil images were significantly better than the corresponding T2-weighted images for delineating the superficial parotid gland. Ultimately, the microscopy coil sequences added over 10 minutes to the examination time.

CT Imaging Categorization and Biomarker Study of Anomalous Tympanic Segment of the Facial Nerves in Patients With Hearing Loss in the Absence of Microtia

The purpose of this study is to categorize anomalous tympanic facial nerve (FN) on high-resolution computed tomography (HRCT) and to determinate the significance of associated temporal bone anomalies and congenital syndromes without microtia in patients with hearing loss. A retrospective analysis of HRCT findings in 30 temporal bones in 18 patients with anomalous FN was performed. Abnormalities of the tympanic FN were categorized as follows: category 1: FN medially positioned, but above the oval window; category 2: FN in the oval window niche; and category 3: FN below the oval window. Potential associated findings that were assessed included stapes abnormalities, oval window atresia, and inner ear anomalies, as well as the presence of a known congenital syndrome with hearing loss. The most common type of anomalous tympanic FN was category 1 (67%, n = 20), following by group 2 (20%, n = 6) and group 3 (13%, n = 4). Stapes anomalies were detected in 77% of temporal bones (n = 23), oval window atresia was detected in 43% of temporal bones (n = 13), and inner ear anomalies were detected in 70% of temporal bones (n = 21). Anomalous tympanic facial nerves in temporal bone with conductive hearing loss were often (60%) not associated with oval window atresia. The combination of aberrant tympanic FN and inner ear anomalies was significantly (P = .038) associated with a known congenital syndrome (6 patients), including CHARGE syndrome, oculo-auriculo-vertebral spectrum, Pierre-Robin sequences, and Down syndrome. Therefore, an anomalous tympanic FN in conjunction with inner ear anomalies appears to be a biomarker for certain congenital syndromes with hearing loss in the absence of microtia.

OPTIMA: a phase II dose and volume de-escalation trial for human papillomavirus-positive oropharyngeal cancer

BACKGROUND

Patients with HPV+ oropharyngeal squamous cell carcinoma were assigned to dose and volume de-escalated radiotherapy (RT) or chemoradiotherapy (CRT) based on response to induction chemotherapy in an effort to limit treatment-related toxicity while preserving efficacy.

PATIENTS AND METHODS

Patients were classified as low-risk (≤T3, ≤N2B, ≤10 pack-year history) or high-risk (T4 or ≥N2C or >10 PYH). After three cycles of carboplatin/nab-paclitaxel, response was assessed using Response Evaluation Criteria in Solid Tumors 1.1. Low-risk patients with ≥50% response received 50 Gray (Gy) RT (RT50) while low-risk patients with 30%-50% response or high-risk patients with ≥50% response received 45 Gy CRT (CRT45). Patients with lesser response received standard-of-care 75 Gy CRT (CRT75). RT/CRT was limited to the first echelon of uninvolved nodes. The primary end point was 2-year progression-free survival compared with a historic control of 85%. Secondary end points included overall survival and toxicity.

RESULTS

Sixty-two patients (28 low risk/34 high risk) were enrolled. Of low-risk patients, 71% received RT50 while 21% received CRT45. Of high-risk patients, 71% received CRT45. With a median follow-up of 29 months, 2-year PFS and OS were 95% and 100% for low-risk patients and 94% and 97% for high-risk patients, respectively. The overall 2-year PFS was 94.5% and within the 11% noninferiority margin for the historic control. Grade 3+ mucositis occurred in 30%, 63%, and 91% of the RT50, CRT45, and CRT75 groups, respectively (P = 0.004). Rates of any PEG-tube use were 0%, 31%, and 82% for RT50, CRT45, and CRT75 groups, respectively (P < 0.0001).

CONCLUSIONS

Induction chemotherapy with response and risk-stratified dose and volume de-escalated RT/CRT for HPV+ OPSCC is associated with favorable oncologic outcomes and reduced acute and chronic toxicity. Further evaluation of induction-based de-escalation in large multicenter studies is justified.

CLINICAL TRIAL REGISTRATION

Clinical trials.gov identifier: NCT02258659.

A printed information leaflet about MRI and radiologists improves neuroradiology patient health literacy

PURPOSE

To determine the health literacy benefit of a printed informational leaflet for patients scheduled to undergo brain magnetic resonance imaging (MRI) scans.

METHODS AND MATERIALS

A two-page leaflet that provided an overview of MRI and the role of radiologists was prepared and given to outpatients scheduled to undergo brain MRI examinations while in the waiting room. A survey composed mainly of yes/no and Likert scale questions pertaining to the leaflet, as well as patient demographics, was administered to the patients.

RESULTS

A total of 147 patients completed the survey, of which 110 (75%) had undergone a prior MRI scan, 120 (82%) stated that their ordering provider explained the reason for the MRI scan, and less than 1% reported having referenced online resources related to MRI. The average score for how well patients understood the MRI scan procedure and how it is reviewed was 4.16/5 (standard deviation 1.18) before versus 4.39/5 (standard deviation 1.08) after reading the leaflet, which was a statistically significant improvement based on the Wilcoxon signed-rank test ( P < 0.01). The score for how helpful the reading material was for explaining what is MRI was 4.06/5 (standard deviation 1.02) and the score for how helpful the reading material was for explaining what is a radiologist was 4.18/5 (standard deviation 0.98).

CONCLUSION

A printed leaflet about MRI and radiologists can serve as an opportunity to educate patients about certain aspects of their scans during their stay in the waiting room.

MR Thermography-Guided Head and Neck Lesion Laser Ablation

Interstitial laser ablation has been successfully used as a minimally invasive treatment option for tumors in many parts of the body, including the head and neck. In this article, we describe the use of MR imaging guidance and mapping sequences for accurate localization of the target lesion, percutaneous interstitial laser ablation methods, and the use of MR thermography for temperature monitoring during laser ablation, with a focus on applications in the head and neck region.

Educational Impact of Trainee-Facilitated Head and Neck Radiology-Pathology Correlation Conferences

The goal of this study was to evaluate the benefits of resident and fellow-facilitated radiology-pathology head and neck conferences. A total of seven resident-facilitated and six fellow-facilitated head and neck radiology-pathology cases were presented as part of the radiology department conference series. The radiology residents were surveyed regarding the perceived quality and effectiveness of the fellow-facilitated sessions. The number of publications yielded from all the cases presented was tracked. Overall, the residents assessed the quality of the fellow-facilitated conferences with an average score of 3.9 out of 5 and the overall helpfulness with an average of 3.5 out of 5. The overall average level of resident understanding among the residents for the topics presented to them by the fellows at baseline was 2.5 out of 5 and 3.4 out of 5 after the presentations, which was a significant increase (p-value < 0.01). There were three peer-reviewed publications generated from the resident presentations and four peer-reviewed publications generated from the fellow presentations, which represents a 54% publication rate collectively. Therefore, trainee-facilitated head and neck radiology-pathology conferences at our institution provide added learning and scholarly activity opportunities.

Case 250: Alpers-Huttenlocher Syndrome

History A 10-year-old girl with global developmental delay and attention deficit hyperactivity disorder was transferred from an outside hospital because of confusion and multiple episodes of left face and arm jerking. Physical examination revealed normal muscle bulk, strength, and tone in the bilateral upper and lower extremities but insuppressible left arm and jaw twitching Lumbar puncture revealed no white or red blood cells, a normal glucose level of 55 mg/dL (3.0 mmol/L) (normal range, 50-80 mg/dL [2.8-4.4 mmol/L]), and an elevated protein level of 81.6 mg/dL (normal range, 15-60 mg/100 dL). A comprehensive metabolic panel revealed lactic acidosis. The patient was initially started on levetiracetam, phenobarbital, phenytoin, and topiramate for status epilepticus. Hepatic dysfunction was not present at initial admission but developed 2 months later, with an alanine aminotransferase level of 90-406 U/L (1.5-6.8 μkat/L) (normal range, 8-37 U/L [0.13-0.62 μkat/L]) and aspartate aminotransferase in the range of 75-187 U/L (1.2-3.1 μkat/L) (normal range, 8-35 U/L [0.13-0.58 μkat/L]). Electroencephalography revealed right parietal and occipital spike-and-wave discharges, with bursts of up to 20 seconds, which were indicative of subclinical status epilepticus. The family history was remarkable for a sister with head lag, developmental delay, seizure disorder, and liver failure.

CT Imaging Findings after Craniosynostosis Reconstructive Surgery

Several surgical options are available for treating the different types of craniosynostosis, including fronto-orbital advancement and remodeling, total or subtotal cranial vault remodeling, barrel stave osteotomy with cranial remodeling, endoscopic suturectomy, monobloc advancement and cranioplasty, and revision cranioplasty. High-resolution, low-dose CT with 3D reconstructed images and volumetric analysis can be useful for evaluating the craniofacial skeleton following surgery. The various types of craniosynostosis surgery and corresponding imaging findings are reviewed in this article.

Comparison between whole-body and head and neck neurovascular coils for 3-T magnetic resonance proton resonance frequency shift thermography guidance in the head and neck region

The purpose of this study is to compare the image quality of magnetic resonance (MR) treatment planning images and proton resonance frequency (PRF) shift thermography images and inform coil selection for MR-guided laser ablation of tumors in the head and neck region. Laser ablation was performed on an agar phantom and monitored via MR PRF shift thermography on a 3-T scanner, following acquisition of T1-weighted (T1W) planning images. PRF shift thermography images and T2-weighted (T2W) planning images were also performed in the neck region of five normal human volunteers. Signal-to-noise ratios (SNR) and temperature uncertainty were calculated and compared between scans acquired with the quadrature mode body integrated coil and a head and neck neurovascular coil. T1W planning images of the agar phantom produced SNRs of 4.0 and 12.2 for the quadrature mode body integrated coil and head and neck neurovascular coil, respectively. The SNR of the phantom MR thermography magnitude images obtained using the quadrature mode body integrated coil was 14.4 versus 59.6 using the head and neck coil. The average temperature uncertainty for MR thermography performed on the phantom with the quadrature mode body integrated coil was 1.1 versus 0.3 °C with the head and neck coil. T2W planning images of the neck in five human volunteers produced SNRs of 28.3 and 91.0 for the quadrature mode body integrated coil and head and neck coil, respectively. MR thermography magnitude images of the neck in the volunteers obtained using the quadrature mode body integrated coil had a signal-to-noise ratio of 8.3, while the SNR using the head and neck coil was 16.1. The average temperature uncertainty for MR thermography performed on the volunteers with the body coil was 2.5 versus 1.6 °C with the head and neck neurovascular coil. The quadrature mode body integrated coil provides inferior image quality for both basic treatment planning sequences and MR PRF shift thermography compared with a neurovascular coil, but may nevertheless be adequate for clinical purposes.

Chapter 4 Thyroid Malignancy: Staging and Restaging

Determining the extent of disease is necessary for guiding the management of thyroid carcinomas. Diagnostic imaging, including ultrasound, computed tomography, magnetic resonance imaging, and nuclear medicine scans, plays an essential role in staging and restaging of thyroid carcinomas. This article reviews the approaches and imaging findings for evaluating the primary tumor, regional lymph node metastases, and distant metastases. In addition, potential pitfalls are discussed and depicted.

Salivary Gland Secretory Carcinoma With High-Grade Transformation, CDKN2A/B Loss, Distant Metastasis, and Lack of Sustained Response to Crizotinib

Background. Salivary gland secretory carcinoma is usually a low-grade neoplasm. However, high-grade transformation can occur and has important implications for clinical outcome. Methods. A patient presented with an enlarging buccal mass. Magnetic resonance imaging (MRI) showed a tumor with a biphasic appearance along the right parotid duct. Local excision and histopathologic examination confirmed the diagnosis of secretory carcinoma with high-grade transformation. ETV6-NTRK3 translocation and loss of CDKN2A/B were identified. Results. The patient subsequently presented with cough and dyspnea and was found to have pleural metastases. Carboplatin and paclitaxel exacerbated the symptoms. Crizotinib resulted in initial symptomatic and radiographic improvement; however, the patient soon succumbed to progressive intrathoracic disease. Conclusions. High-grade salivary gland secretory carcinoma can have a biphasic appearance on MRI. Diagnosis is confirmed by the histologic appearance and associated ETV6-NTRK3 fusion. Additional molecular genetic events leading to transformation are unknown; however, loss of CDKN2A/B may have contributed. Treatment with multimodal chemotherapy was of limited benefit.

"Finding a Voice": Imaging Features after Phonosurgical Procedures for Vocal Fold Paralysis

Altered communication (hoarseness, dysphonia, and breathy voice) that can result from vocal fold paralysis, secondary to numerous etiologies, may be amenable to surgical restoration. In this article, both traditional and cutting-edge phonosurgical procedures targeting the symptoms resulting from vocal fold paralysis are reviewed, with emphasis on the characteristic imaging appearances of various injectable materials, implants, and augmentation procedures used in the treatment of vocal fold paralysis. In addition, complications of injection laryngoplasty and medialization laryngoplasty are illustrated. Familiarity with the expected imaging changes following treatment of vocal fold paralysis may prevent the misinterpretation of posttreatment changes as pathology. Identifying common complications related to injection laryngoplasty and localization of displaced implants is crucial in determining specific management in patients who have undergone phonosurgical procedures for the management of vocal fold paralysis.

Lacrimal gland abscess presenting with preseptal cellulitis depicted on CT

Background

Pyogenic lacrimal gland abscesses are uncommon and thus may not be immediately clinically recognized without a high index of suspicion.

Findings

We present two patients with preseptal cellulitis and characteristic low-attenuation fluid collections in the lacrimal glands demonstrated on computed tomography (CT).

Conclusions

Lacrimal gland abscesses should be considered when dacryoadenitis is refractory to medical treatment. Indeed, these cases highlight the value of prompt recognition of lacrimal abscess through ophthalmologic referral and the use of diagnostic imaging. Both patients were successfully treated via incision and drainage.

Imaging Features of Juvenile Xanthogranuloma of the Pediatric Head and Neck

BACKGROUND AND PURPOSE

Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis primarily affecting children. The purpose of this study was to characterize the imaging features of histologically confirmed pediatric head and neck juvenile xanthogranuloma.

MATERIALS AND METHODS

A retrospective review was performed of medical records and imaging of histologically confirmed head and neck juvenile xanthogranuloma.

RESULTS

Ten patients (6 girls, 4 boys) 1 month to 12 years of age were imaged with ultrasound only (n = 1), CT only (n = 2), CT and ultrasound (n = 1), MR imaging only (n = 3), or MR imaging and CT (n = 3). Masses were solitary in 9 patients and multiple in 1. Solitary masses were located in the external auditory canal, infra-auricular region, infratemporal fossa with intracranial extension, frontal scalp, and subperiosteal space eroding the calvaria and along the dura. One patient with disseminated disease had scalp-, calvarial-, and dural-based masses. Clinical presentation included a mass or alteration in function. On sonography, juvenile xanthogranuloma appeared hypoechoic. On contrast-enhanced CT, masses appeared homogeneous and isoattenuating with muscle and sometimes eroded bone. On MR imaging, compared with the cerebral cortex, the masses appeared hyper- or isointense on T1 and hypo- or isointense on T2, had decreased diffusivity, and enhanced homogeneously. Juvenile xanthogranuloma was not included in the differential diagnosis in any case.

CONCLUSIONS

Head and neck juvenile xanthogranuloma has varied manifestations. Mild hyperintensity on T1, hypointensity on T2 compared with the cerebral cortex, decreased diffusivity, and homogeneous enhancement are characteristic. Awareness of these features should prompt radiologists to include juvenile xanthogranuloma in the differential diagnosis of pediatric head and neck masses.

Posttreatment Imaging of the Paranasal Sinuses Following Endoscopic Sinus Surgery

Endoscopic sinus surgery is a minimally invasive option for the treatment of several nonneoplastic indications, particularly for medically refractory sinusitis and polyposis. Numerous interventions can be performed through endoscopic sinus surgery, many of which may be performed together during the same procedure. There are also a variety of complications that can result from endoscopic sinus surgery. Radiological imaging plays an important role in the evaluation of patients after endoscopic sinus surgery. Thus, it is important to be familiar with the expected and complicated imaging findings associated with endoscopic sinus surgery, which are reviewed in this article.

Case 217: sinonasal organized hematoma

HISTORY

A 15-year-old boy presented to the emergency department with intractable epistaxis. He had a prior history of epistaxis typically lasting 5-10 minutes and consisting of up to four episodes per year for several years. Otherwise, the patient had no relevant medical history, and he denied having prior trauma, surgery, bleeding diathesis, fever, chills, or vision changes. Likewise, the patient had no relevant family history. The patient's coagulation panel was unremarkable and included a prothrombin time of 15.4 seconds, an international normalized ratio of 1.2, and a partial thromboplastin time of 29.3 seconds. A thin-section unenhanced sinus computed tomography (CT) examination was performed. In addition, magnetic resonance (MR) imaging of the sinuses without and with intravenous contrast material was performed. The epistaxis was treated with nasal packing, which prevented further bleeding. Biopsy of the lesion was subsequently performed.

Oral Cavity Clear Cell Odontogenic Carcinoma

A case of clear cell odontogenic carcinoma of the oral cavity is described in this sine qua non radiology-pathology correlation article. CT demonstrated a solid and cystic mass arising from the mandible. Histology demonstrated variably-sized nests of clear to pale eosinophilic cells with occasional central necrosis embedded in a hyalinized to fibrocellular stroma. The specimen was also positive for the characteristic rearrangement of the EWSR1 (22q12) locus in 93.5% of interphase cells.

Hairy Polyp of the Nasopharynx Arising from the Eustachian Tube

Hairy polyps of the nasopharynx display characteristic radiological imaging findings, including the presence of fat in the polypoid mass. Furthermore, diagnostic imaging is useful for delineating the site of origin of these lesions, which can facilitate surgical planning. For instance hairy polyps that arise from the right Eustachian tube can be amputated via a trans-nasal approach with endoscopy, but may necessitate a two stage approach in order to avoid injury to critical structures, such as the internal carotid artery. On histology, hairy polyps comprise an outer keratinizing squamous epithelium with adnexal tissue, including hair follicles, and central fibroadipose and cartilaginous tissue. These features are exemplified in this sine qua non radiology-pathology correlation article.

Stapediovestibular dislocation depicted on temporal bone computed tomography with 3D rendering

Stapediovestibular dislocation is an unusual form of ossicular trauma. In this article, a case of medial stapediovestibular dislocation and pneumolabyrinth due to penetrating injury with a stick diagnosed on temporal bone CT is described. In particular, 3D CT renderings can aid in the evaluation of the displaced ossicles.

Successfully treated symptomatic fusiform basilar artery aneurysm in a patient with hindbrain malformation via inverted Y-stenting

A double overlapping reverse Y-stent approach to creating flow diversion using traditional open-cell stent technology was evaluated as a treatment option symptomatic fusiform basilar aneurysms. A 36-year-old man with a complex hindbrain malformation presented with acute ocular dysmotility due to a rapidly enlarging fusiform basilar artery aneurysm. The aneurysm was treated by insertion of two stents into the vertebrobasilar system in an inverted Y-configuration from the basilar tip to the V4 segments of the bilateral vertebral arteries, essentially creating flow diversion without using a dedicated flow diversion device. This resulted in immediate symptomatic improvement. The stents remained patent and the aneurysm was obliterated at 6 months follow-up. Furthermore, the patient remained free of associated symptoms at 10 months follow-up. Thus, the double stenting technique can be used instead of a flow diversion device to effectively create flow diversion, promote aneurysm sac thrombosis, and lead to resolution of symptoms in large fusiform basilar artery aneurysms.

Successfully treated symptomatic fusiform basilar artery aneurysm in a patient with hindbrain malformation via inverted Y-stenting

A double overlapping reverse Y-stent approach to creating flow diversion using traditional open-cell stent technology was evaluated as a treatment option symptomatic fusiform basilar aneurysms. A 36-year-old man with a complex hindbrain malformation presented with acute ocular dysmotility due to a rapidly enlarging fusiform basilar artery aneurysm. The aneurysm was treated by insertion of two stents into the vertebrobasilar system in an inverted Y-configuration from the basilar tip to the V4 segments of the bilateral vertebral arteries, essentially creating flow diversion without using a dedicated flow diversion device. This resulted in immediate symptomatic improvement. The stents remained patent and the aneurysm was obliterated at 6 months follow-up. Furthermore, the patient remained free of associated symptoms at 10 months follow-up. Thus, the double stenting technique can be used instead of a flow diversion device to effectively create flow diversion, promote aneurysm sac thrombosis, and lead to resolution of symptoms in large fusiform basilar artery aneurysms.

Uremic leontiasis ossea

Uremic leontiasis ossea is a rare manifestation of renal osteodystrophy clinically characterized by jaw enlargement, widening of the nares, flattening of the nasal bridge, and increased interdental spacing. Computed tomography (CT) findings are particular characteristic and include serpiginous tunneling within the maxillofacial bones and cortical bone resorption. Nuclear medicine scans are also useful for demonstrating hyperplasia of the parathyroid glands. Ultimately, the diagnosis of uremic leontiasis ossea can be made non-invasively through a combination of clinical parameters and imaging findings, as described in this article.

Diagnostic imaging features of congenital nose and nasal cavity lesions

A wide variety of congenital nasal lesions can present to clinical attention due to airway obstruction, the presence of a mass, and/or cosmetic deformity, including pyriform aperture stenosis, choanal atresia, nasopharyngeal atresia, arrhinia, congenital germline fusion cysts, cephaloceles, neuroglial heterotopia, nasolacrimal duct mucoceles, hamartomas, supernumerary nostril, and bifid nose. Computed tomography and magnetic resonance imaging, which are the main imaging modalities used to characterize these lesions, often serve complementary roles. Familiarity with embryology and anatomy is also essential for recognizing the diagnostic imaging findings related to congenital nasal lesions.