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Everything you need to know about Computed Tomography (CT) & CT Scanning

Neuroradiology: Head and Neck Pathology Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Neuroradiology ❯ Head and Neck Pathology

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  • “Substernal nodular goiter usually results from simple goiter. Although bilateral glands are often involved, the large lesions are usually located in unilateral gland. Large substernal nodular goiter often causes compression of surrounding structures, secondary hyperthyroidism and malignant changes. Therefore, surgery will be indicated when the diagnosis is confirmed . However, if it is treated with surgery, the operative bleeding risk was high. Most of the cases are operated upon via a cervical or combined cervical-thoracic approach. Substernal goiter resection performed through cervical approach is minimally invasive with less potential complications. The patients don’t require thoracotomy and rehabilitate fast postoperatively.”
    Surgical treatment of large substernal thyroid goiter: analysis of 12 patients
    Bo Gao et al.
    Int J Clin Exp Med. 2013; 6(7): 488–496.
  • "Substernal goiter refers to the thyroid mass grows along dermal sternum from the neck to the substernal portion, descending below the thoracic inlet. The currently accepted definition of an intrathoracic goiter is a thyroid gland with more than 50% of its mass located below the thoracic inlet. It is characterized by slow progression and a longer course of illness. If the substernal goiter compresses the adjacent esophagus, trachea, nerves and blood vessels, then the corresponding symptoms would occur.”
    Surgical treatment of large substernal thyroid goiter: analysis of 12 patients
    Bo Gao et al.
    Int J Clin Exp Med. 2013; 6(7): 488–496.
  • "’The role of the radiologist in evaluation of substernal thyroid goiters is to provide the surgeon with an anatomic roadmap to guide surgical intervention. The radiologist provides an accurate account of the substernal extent of the mass and describes its impact on the trachea, esophagus, and vascular structures. Imaging the patient with the arms overheard can result in misleading substernal localization of the goiter. Substernal thyroid goiters should be imaged with the patient’s arms by the sides, because this is the position the patient will be in during surgery, and this position most accurately reflects the true anatomic location of the gland.”
    Preoperative Imaging of Thyroid Goiter: How Imaging Technique Can Influence Anatomic Appearance and Create a Potential for Inaccurate Interpretation
    Derek B. Pollard, Colin W. Weber and Patricia A. Hudgins
    American Journal of Neuroradiology May 2005, 26 (5) 1215-1217
  • “Surgeons have long been familiar with the impact when a patient with a large thyroid goiter simultaneously raises both arms overhead. Pemberton sign or “thyroid cork” describes the physical manifestation of marked facial plethora resulting from jugular vein compression when the thoracic inlet rises so that it is temporarily filled by a large substernal goiter. Although elevating the patient’s arms and shoulders above the head is desirable to eliminate the beam-hardening artifact from the shoulders, it may also have the adverse consequence of temporarily increasing the apparent descent of a substernal goiter.”
    Preoperative Imaging of Thyroid Goiter: How Imaging Technique Can Influence Anatomic Appearance and Create a Potential for Inaccurate Interpretation
    Derek B. Pollard, Colin W. Weber and Patricia A. Hudgins
    American Journal of Neuroradiology May 2005, 26 (5) 1215-1217
  • “The incidence of INs has increased over time with the latest imaging techniques. For example, it is known that pulmonary nodules may be identified in up to 50% of chest computed tomography (CT) studies in smoking individuals and up to 25% of studies of non-smokers. Renal and hepatic findings occur in about 15% of individuals. In a study examining 1192 asymptomatic patients receiving a whole-body CT scan, 86% had an abnormal finding, and 37% of patients were referred for follow-up or treatment. Increased access to medical imaging and the propensity of physicians to favour over-investigating to avoid medical litigation can be identified as contributing factors to the in- creased frequency of Ins”. 


    The incidence and management of non-head and neck incidentalomas for the head and neck surgeon 
 Sahovaler A et al.
 Oral Oncology; Volume 74, November 2017, Pages 98–104
  • “The incidence of INs has increased over time with the latest imaging techniques. For example, it is known that pulmonary nodules may be identified in up to 50% of chest computed tomography (CT) studies in smoking individuals and up to 25% of studies of non-smokers. Renal and hepatic findings occur in about 15% of individuals. In a study examining 1192 asymptomatic patients receiving a whole-body CT scan, 86% had an abnormal finding, and 37% of patients were referred for follow-up or treatment”. 


    The incidence and management of non-head and neck incidentalomas for the head and neck surgeon 
 Sahovaler A et al.
 Oral Oncology; Volume 74, November 2017, Pages 98–104
  • “Advances in medical imaging technology have provided more sensitive, detailed and higher resolution images. Consequently, the frequency of INs has increased. A considerable volume of our referrals emerges from colleagues that seek our expertise in managing unexpected imaging findings in the head and neck region. Similarly, head and neck surgeons can encounter incidental findings in regions outside their “comfort zone”. Many times, we rely on the radiology report to suggest the next step in work-up. On other occasions, we initiate an immediate referral to another specialist without knowing if it is the most appropriate next step in management.”. 


    The incidence and management of non-head and neck incidentalomas for the head and neck surgeon 
 Sahovaler A et al.
 Oral Oncology; Volume 74, November 2017, Pages 98–104
  • “The incidence of INs has increased over time with the latest imaging techniques. For example, it is known that pulmonary nodules may be identified in up to 50% of chest computed tomography (CT) studies in smoking individuals and up to 25% of studies of non-smokers. Renal and hepatic findings occur in about 15% of individuals. In a study examining 1192 asymptomatic patients receiving a whole-body CT scan, 86% had an abnormal finding, and 37% of patients were referred for follow-up or treatment. Increased access to medical imaging and the propensity of physicians to favour over-investigating to avoid medical litigation can be identified as contributing factors to the increased frequency of INs.”.

    The incidence and management of non-head and neck incidentalomas for the head and neck surgeon 
 Sahovaler A et al.
 Oral Oncology; Volume 74, November 2017, Pages 98–104
  • Squamous Cell Carcinoma of the Neck:Staging
    - T1: tumor limited to one subsite of and = 2 cm
    - T2: > 1 subsite or > 2 cm, < 4cm without hemilarynx fixation
    - T3: tumor > 4cm with hemilarynx fixation
    - T4: tumor invading local structures (thyroid/cricoid cartilage, cervical soft tissues)
  • Squamous Cell Carcinoma of the Neck
    - Commonly are necrotic
    - Spread to local nodes (>50% at presentation)
    - Usually aggressive with poor prognosis
    - Can simulate lymphoma but nodes are usually more necrotic
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