Board Review Cases – Head and Neck

This playlist is a collection of only the head and neck imaging board review cases on this site. This includes pathologies such as head and neck cancer and skull base abnormalities.

These cases are geared towards preparation for the radiology resident ABR core exam, although similar material is used for the ABR certifying exam general and neuroradiology sections as well as neuroradiology CAQ. The format of this playlist is case-based. Each case consists of a series of images followed by 1 or 2 questions. The first question is usually to name the diagnosis, while the second is a multiple choice question to test deeper understanding of the specific condition. Try to get the diagnosis before you see the second questions.

 

CT (computed tomography) face radiology search pattern

When you start taking call as a radiology resident, a common test you are going to encounter is a maxillofacial CT, or face CT. This is especially true if you are taking call at a level 1 or level 2 trauma center. A lot of times, this is done in conjunction with a head and/or cervical spine CT. This is an extremely common test in the setting of trauma, including assault and car accidents (MVA or MVC). The key in these settings is to rule out a significant fracture or soft tissue injury to the face.

Because there are a lot of structures, it is important to have a useful search pattern. Reconstructions, especially the coronal reconstruction, are key when interpreting CT of the face. These allow you to see key structures that are parallel to the slice plane on axial images. Symmetry is extremely helpful, as the left should match the right. Additionally, making sure all the fat and fascia planes are clean is very useful.

This video will walk you through a step-by-step approach to evaluating a CT of the face. I recommend a pattern where you start with the coronals at the cranial (top) part of the image, and then work your way down. In this way, you can look at the brain, orbits, sinuses, palate, mandible, and so forth, minimizing the risk of missing a significant finding. Then you can repeat the pattern with the axial images. Finally, the sagittal images are a nice troubleshooting tool, especially for the mandible and cervical spine. As you practice, you will find you can move more quickly through your search without necessarily focusing on each individual element for too long.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may be involved with patients with facial injuries and other abnormalities.

 

See this and other videos on our Youtube channel.

Board Review 2 – Case 5

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a patient with headache. Images are from an MR angiogram of the neck. The first few images show absence of filling of the left vertebral artery. This could theoretically be from atherosclerotic disease or thrombosis, but there is filling on a contrast enhanced MRA of the neck. This is because the flow in the vertebral artery is reversed in the setting of occlusion of the proximal subclavian artery.

The diagnosis is: subclavian steal

Board Review 2 – Case 2

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a patient with hearing loss some thickening of the bone in the external auditory canals. It is bilaterally symmetric and causes severe EAC narrowing.

The diagnosis is: surfer’s ear, or exostosis of the external auditory canal.

Board Review 2 – Case 1

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case is a mass in the right cerebellopontine angle and internal auditory canal. The differential for these masses includes schwannoma, meningioma, arachnoid cyst, and epidermoid. The key to differentiating this mass from others are that it is solid, centered in the internal auditory canal, and has a few areas of cystic degeneration or necrosis.

The diagnosis is: vestibular schwannoma

Neuroradiology search patterns

As radiologists, we often forget that we didn’t know how to go through a study from the beginning. This playlist will be a collection of videos on how to approach studies from scratch. This may be particularly useful to beginning medical students and residents who haven’t sat down at the PACS and looked through a study many times.

Be sure to check back often as more videos are added that cover your favorite neuroradiology exams, or check out our full channel on Youtube.

Noncontrast MRA (magnetic resonance angiogram) neck radiology search pattern

Another frequent study will encounter in neuroradiology is an MRA (magnetic resonance angiogram) of the neck. This test is frequently used to evaluate the arteries of the neck, including the carotid and vertebral arteries.

MRA of the neck can be performed without contrast using a technique called time of flight imaging, which depends on signal from flowing blood to create the image. MRA of the neck can also be performed with contrast in certain situations, such as need to better evaluate the aortic arch and great vessel origins or need to imaging dynamically.

MRA of the neck is primarily used to evaluate for vessel occlusion or narrowing, although vascular malformations may also be evaluated. It can also be used to follow up on vascular findings seen on other studies, such as doppler ultrasound of the carotids. The most common indication, however, is to evaluate for stroke, when it is combined with MRI and MRA of the brain.

This video will walk you through a step-by-step approach to evaluating an MRA of the neck, including how to approach each vessel. I use an approach that moves from anterior to posterior and then right to left. While others may have a different strategy, the most important part is to have a strategy and stick to it.

The level of this lecture is appropriate for medical students, junior residents, and trainees in other specialties who have an interest in neuroradiology or may see patients with atherosclerotic disease or stroke.

See this and other videos on our Youtube channel.

Board Review 1 – Case 20

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a CT of the orbits with proptosis and enlargement of the extraocular muscles. There is relative sparing of the myotendinous junction (where the muscles meet the globe).

The diagnosis is: Graves ophthalmopathy

Graves disease is one of the most common causes of bilateral opthalmopathy, although findings do not have to be symmetric. Findings often do not improve with treatment of Graves disease.

Board Review 1 – Case 17

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

In this patient with trigeminal neuralgia, there is a mass in the left cerebellopontine angle which is causing mass effect on the pons and cerebellar peduncle. Its imaging appearance is close to that of CSF on all sequences except diffusion weighted imaging (DWI), on which it is bright.

Lesions of the cerebellopontine angle can be cystic or solid. Cystic appearing masses include arachnoid cysts and epidermoid.

The diagnosis is: epidermoid

Epidermoids of the cerebellopontine angle are inclusion cysts which contain secretions which are bright on DWI, distinguishing them from arachnoid cysts. They tend to have minimal if any enhancement.

Board Review 1 – Case 15

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case starts with a CT showing bilateral temporal bone fractures after a major trauma. There are a number of potential complications of temporal bone fractures, but on the left the ossicles are no longer in alignment.

The diagnosis is: ossicular dissociation from trauma

Fractures of the temporal bone can cause a number of complications, including meningitis, conductive hearing loss, and facial nerve injury. This shows dislocation of the malleus and incus on the left. Fractures should be classified by whether they involve the otic capsule or spare the otic capsule.