Head and Neck Imaging
Core concepts
Understand the anatomy of the neck spaces: parapharyngeal, retropharyngeal, submandibular, sublingual, and carotid spaces, and the lesions that arise in each. Learn the imaging of head and neck cancer: squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx, and the role of CT/MRI and PET-CT in staging and nodal disease. Know the laryngeal anatomy (supraglottic, glottic, subglottic) and the significance of the anterior commissure. Understand salivary gland pathology: pleomorphic adenoma versus Warthin tumor versus malignancy. Learn the imaging of the thyroid (nodule, goiter, cancer) and parathyroid adenoma. Understand the skull base foramina and the cranial nerves that pass through them, and the imaging of sinonasal disease.
Traps
Nodal staging depends on size, necrosis, and extranodal extension. The retropharyngeal space extends from the skull base to the mediastinum; infection can spread inferiorly. Do not confuse a branchial cleft cyst with a necrotic node. Remember that glottic tumors present early with hoarseness, while supraglottic tumors present late. Parathyroid adenomas are often small and may require 4D CT or sestamibi.
Rule of thumb
Localize neck masses by space first, then by tissue of origin. A cystic mass in a young adult in the lateral neck is likely a branchial cleft cyst; in an older adult, consider a necrotic nodal metastasis.