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ì CALCIFIED ATHEROSCLEROTIC PLAQUE
Defini&on: Steno'c atheromatous plaque in the extracaro'd vasculature.
Radiographic findings: ì Loca'on: • At the greater cornu of the hyoid bone • Adjacent to the cervical vertebra C3, C4, or the intervertebral space between them. ì Periphery and shape: • Mul'ple, irregular in shape • Sharply defined border • Ver'cal linear distribu'on ì Internal Structure: • Heterogeneous radiopacity with radiolucent voids
ì Differen&al Diagnosis:
• Calcified tri'ceous car'lage
ì Management: • Risk factor for cerebrovascular accident and stroke • Referral to a physician
SIALOLITH ì Defini&on: • Stones within ducts of salivary glands ì Clinical features: • Men (middle and later years) • Usually singly (70% to 80%), mul'ple in the paro'd gland
• Asymptoma'c (discomfort intensify at meal'mes) • 9% with recurrent sialolithiasis • 10% with nephrolithiasis
Radiographic Features:
ì Loca'on:
• 83% to 94% in the submandibular gland Ø 50% in distal por'on of Wharton’s duct Ø 20% in the proximal por'on Ø 30% in the gland
• 4% to 10% in the paro'd gland
• 1% to 7% in the sublingual gland
ì Periphery and Shape:
• In duct-‐ cylindric, very smooth border
• In hilus of gland-‐ larger, more irregularly shaped
ì Internal Structure:
• Homogenous radiopacity
ì Applied Radiology:
• Periapical view at lower premolar and molar apices
• Distal por'on of Wharton’s duct: Mandibular occlusal view
• More posterior loca'on: Lateral oblique view or panoramic image
• Paro'd duct gland: Ø Periapical film in the buccal ves'bule Ø Anteroposterior skull view (“blows out” the cheek)
• Noncalcified stone: Sialography
ì Differen&al Diagnosis:
• Calcifica'on of the lymph nodes
• Phleboliths
ì Management:
• Small stone: “Milked out” by bimanual palpa'on
• Large stone/in proximal duct: Nonsurgical or minimally invasive sialolithomy
PHLEBOLITHS
ì Defini&on:
• Calcified thrombi in veins/ venulae, or sinusoidal vessels of hemangiomas.
ì Clinical features:
• Hemangioma
• Swollen so_ 'ssue with throbbing and blanching
• Fluctuate in size
• Ausculta'on reveal a bruit (in cavernous type)
Radiographic Features:
ì Loca'on: In hemangiomas ì Periphery and Shape: • Round or oval (from the side resemble a straight or slightly curved
sausage)
• Mul'ple, random and clustered distribu'on • 6mm diameter • Smooth periphery ì Internal structure:
• Homogenous radiopacity and lamina'ons (give a bull’s eye or “target” appearance)
• Radiolucent center
ì Differen&al Diagnosis:
• Sialolith
• Calcified lymph nodes
LARYNGEAL CARTILAGE CALCIFICATIONS
ì Defini&on:
• Calcifica'on or ossifica'on of hyaline car'lage in the thyroid and tri'ceous car'lages.
ì Clinical features:
• Incidental radiographic finding with no clinical features
Radiographic Features: ì Loca'on: • Inferior to the greater cornu of the hyoid bone • Adjacent to the superior border of C4
ì Periphery and Shape: • 7 to 9 mm in length, 2 to 4 mm in width • Smooth and well defined periphery ì Internal Structure: • Homogenous radiopacity (occasionally with outer cortex)
ì Differen&al Diagnosis:
• Calcified atheromatous plaque
ì Management:
• No treatment
RHINOLITH/ANTROLITH ì Defini&on:
• Calcerous concre'ons in nose (rhinoliths) or antrum of maxillary sinus (antroliths)
ì Clinical Features:
• Asymptoma'c for a long period of 'me
• Pain, ulcera'on, and conges'on (the expanding mass impinge on mucosa)
• Unilateral rhinnorhea
• Sinusi's
• Headache
• Epistaxis
• Anosmia
• Fetor
• Fever
Radiographic Features: ì Loca'on: • Rhinolith in the nose • Antrolith in the antrum of maxillary sinus ì Periphery and Shape: • A variety of shapes and sizes ì Internal Structure: • Homogenous or heterogenous radiopacity • Some'mes with lamina'ons • Density may exceed the surrounding bone
ì Differen&al Diagnosis: • Osteoma • Odontoma • Surgical ciliated cyst • Mycolith ì Management: • Referred to otorhinolaryngologist (for endonasal surgical
removal) • Lithotripsy if large