3.4: Clinical radiology, imaging differential diagnosis and approach
3.4.1
CLINICAL RADIOLOGY & IMAGING DIFFERENITAL DIAGNOSIS
Padma Challa Ramprakash, Kanimozhi D, Anitha Alaguraj
Abbreviations
- ABC – Aneurysmal bone cyst
- AICA – Anterior inferior cerebellar artery
- AVF – Arterio-venous fistula
- AVM – Anteriovenous malformation
- BCC – Branchial cleft cyst
- CN – Cranial nerve
- CPA – Cerebellopontine Angle
- DD – Differential diagnosis
- FD – Fibrous dysplasia
- GCT – Giant cell tumour
- GJ – Glomus jugulare
- HC – Hypoglossal canal
- IAC – Internal auditory canal
- IJV – Internal jugular vein
- JB – Jugular bulb
- JF – Jugular foramen
- MC – Most common
- MM – Multiple myeloma
- NF2 – Neurofibromatosis 2
- NHL – Non-Hodgkin’s lymphoma
- OKC – Odontogenic keratocyst
- OM – Osteomyelitis
- PA – Petroux apex
- PICA – Posterior inferior cerebellar artery
- RPS – Retropharyngeal space
- SBC – Simple bone cyst
- SCC – Squamous cell carcinoma
- SVC – Superior vena cava
- TB – Tuberculosis
- V3 – Mandibular branch of trigeminal nerve
- VBD – Vertebro-basilar dolichoectasia
Introduction
This chapter gives quick reference or summary to the imaging differential diagnosis one has to think through while interpreting a head and neck lesion on imaging in relevant areas. The list is comprehensive, yet not necessarily complete. Readers are urged to see the relevant chapters for further points and differentiating features. Some overlap is expected but hopefully it will reinforce the thought process and ensure it is reflected in apt reporting and appropriate patient care.
Paranasal sinuses and nasal cavity
Differential diagnosis for opacified sinus without bone destruction
Opacified sinus with bone expansion with or without destruction
- • Mucocele
- • Sinonasal polyposis
- • Antrochoanal polyp
- • Infection – Aspergillosis
- • Wegener’s granulomatosis
- • Hemosinus
- • Inverted papilloma
- • Plasmacytoma
- • Lymphoma
- • Fibrous dysplasia
- • Aneursymal bone cyst.
- • Angiofibroma
- • Esthesioneuroblastoma
- • Sarcoma, Rhabdomyosarcoma
- • Carcinoma, melanoma
Hyperdense sinus
Unilateral opacification of nasal cavity
Imaging differentials for soft tissue at nasal vault/cavity
Benign
Malignant
Cystic lesions at the nasal vault
Primary bone density sinus tumours
Benign
Malignant
Orbits
DD of calcific density lesions
- Outside the globe
- Within the globe
- • Cataract
- • Old trauma
- • Old infection/inflammation – chronic osteomyelitis
- • Phthisis bulb
- • Retinoblastoma
- • Foreign body
- • Hamartoma
- • Choroidal osteoma
- • Optic drusen
- • Scleral calcification (in systemic hypercalcemic status like – hyperparathyroidsum, hyperviraminosis D, sarcoidosis, chronic renal disease)
- • Retrolental fibroplasia.
- • Cataract
- Others
Hypo attenuating lesions in orbit
Soft tissue attenuating lesions involving the globe
Soft tissue attenuating intraconal lesion with optic nerve involvement
Intraconal lesion without optic nerve involvement
Lesions from the muscle cone
Lesions outside the muscle cone (extraconal – intraorbital lesion)
Extraconal, extraorbital lesions
- A. From adjacent sinuses:
- • Tumours: squamous cell carcinoma (SCC)
- • Paranasal sinusitis
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- • Tumours: squamous cell carcinoma (SCC)
