ABSTRACT ID - IRIA-1230 Imaging differentials in granulomatous diseases of head and neck: a...
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Transcript of ABSTRACT ID - IRIA-1230 Imaging differentials in granulomatous diseases of head and neck: a...
ABSTRACT ID - IRIA-1230
Imaging differentials in granulomatous diseases of
head and neck: a retrospective study
Aims and objective 1. To analyse the varied etiology and recognise radiologic
patterns of granulomatous diseases in the head and neck. 2. Formulate an appropriate imaging differential diagnosis for
granulomatous disease manifestations in the head and neck
Materials and methods Retrospective analysis of cross-sectional imaging done for
granulomatous diseases of head and neck, using specific key word search from our PACS database
Imaging features of various cases were analysed and categorised based on the etiologies as proved by histopathological /microbiological / serological examination
Objectives & Methodology
Granulomatous diseases- Etiology
Autoimmune
Granulomatosis with polyangitis (Wegener’s granulomatosis)Churg StraussIgG4 diseaseBehcet’s disease
Infection
TBFungalLeprosyActinomycosisRhinoscleromaSyphilisCat scratch
OthersLangerhans Cell histiocytosisErdheim Chester disease Systemic lupus nephritisSinus HistiocytosisRelapsing polychondritisRheumatoid arthritis
HereditaryChronic GD
IdiopathicSarcoidosis
Analyzed cases
1784 cases
847
407
265
8383 18
17 51810 121063
FungalTBSarcoidosisChurg straussActinomycosisWegener'sIgG4 diseaseLeprosyWegener'sLCHErdheim chesterLCHRelaps polychSyphilis
Biopsy proven granulomatous diseases
33
1713
10
6
6 5
3 1 1 1 FungalTuberculosisSarcoidosisLCHRelapsing polychonActinomycosisWegenersChurg straussSyphilisLeprosyRhinosceroma
Granulomatosis with polyangitis(Wegener’s granulomatosis)
-
SINONASAL INVOLVEMENTSoft tissue opacification of all sinuses[ ]
ORBITAL INVOLVEMENT Enhancement along the orbital apex bilaterally [ ]
Granulomatosis with polyangitis
SINONASAL & BONE INVOLVEMENTErosion of inferior nasal septum, nasal turbinates and hard palate [ ] Associated soft tissue thickening in the maxillary and ethmoid sinuses
Sarcoidosis
SINONASAL INVOLVEMENTSoft tissue opacification [ ] of left maxillary & ethmoid sinuses
SALIVARY GLAND INVOLVEMENTEnlarged parotid glands bilaterally, right more than left [ ]
Sarcoidosis
ORBITAL INVOLVEMENTDiffusely enlarged homogenously enhancing lacrimal glandsThickening of the extra ocular muscles bilaterally [ ]
AERODIGESTIVE INVOLVEMENTAsymmetric thickening [ ] of the tracheal wall in its upper 2/3 rd
Fungal
ORBITAL INVOLVEMENTHomogenously enhancing retrobulbar soft tissue mainly involving the extraconal fat and part of intraconal fat, causing bony erosion and intracranial extension[ ]
Fungal
• SINONASAL & INTRACRANIAL INVOLVEMENT Involvement of sinuses extending into the orbit & causes extra dural thickening [ ]
• Culture –invasive aspergillosis• Sinusitis with T2 hypointense contents,
intracranial extension , resultant infarcts [ ] • Culture –angioinvasive mucormyosis
Langerhans cell histiocytosis
ORBITAL & SINONASAL INVOLVEMENT Erosion of bony walls of sinuses, nasal septum, pterygoid bones Enhancing soft tissue encasing the optic nerve in intraconal fat region bilaterally [ ]
Langerhans cell histiocytosis
ORBITAL , SKULL BASE, INTRACRANIAL INVOLVEMENT Enhancing soft tissue density in the sella [ ] and right temporal lobe [ ]Lytic destruction [ ]of the lateral wall of left orbit, adjacent zygomatic bone and greater wing of sphenoid
TB
NODAL INVOLVEMENT Multiple rim-enhancing low-attenuation lymph nodes[ ]
AERODIGESTIVE TRACT INVOLVEMENT Heterogenous thickening and enhancement [ ] of vocal cords, valeculla, enlarged neck nodes
TB
SKULL BASE INVOLVEMENT Multiple ring enhancing lesions[ ] in the basal cistern with leptomeningeal enhancement [ ] along the basal meninges
IgG4 disease Erdheim Chester disease
Involvement of the orbit [ ] & infra temporal region [ ]
Involvement of the [ ]orbit and the tentorium cerebelli [ ]
Lepromatous leprosy
Rhinoscleroma
SINONASAL ORBITAL INVOLVEMENT Sinusitis, soft tissue thickeing at the right medial cantuhus. Synechia between the sinus inferior turbinate & septum [ ]
ORBITAL INVOLVEMENT Soft tissue in both nasal cavities, paranasal sinuses, uniformly hyperintense, large extraconal component [ ]
Relapsing polychondritis
AERODIGESTIVE TRACT INVOLVEMENT Airway laryngeal stenosis from supra to subglottis, soft tissue density[ ] around trachea, ossified laryngeal cartilage[ ], tracheostomy tube in situ [ ]
Imaging differentials based on radiological manifestations seen in our study
ORBITWegener’s
FungalSarcoidosis
IgG4Leprosy
Erdheim Chester Disease
Rhinoscleroma
SINONASAL Wegener’s
Fungal TuberculosisSarcoidosis
IgG4 disease
VASCULARWegener’s
Fungal TB
CRANIAL NERVES
SarcoidosisTB
Leprosy
SKULL BASETuberculosis
FungalLCH
Wegener’s
AERODIGESTIVE TRACT
Wegener’sTuberculosis
Relapsing Polychondritis
Sarcoidosis
Conclusion & References
Conclusion Knowledge of the clinical and radiologic patterns of
granulomatous diseases in the head and neck will allow interpreting radiologists to provide a useful differential diagnosis, thus facilitating appropriate clinical management
References
1. Granulomatous Disease in the Head and Neck: Developing a Differential Diagnosis. O.K Nwawka, R Nadgir, A Fujita. Radiographics volume 34, issue 5 September-October 2014
2. Radiology Review Manual. Wolfgang Dahnert, 6th edition
3. CT and MR imaging of the whole body. John Haaga. 4th edition