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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5770_Библиотеки_им_академика_М_И_Перельмана.pdf
6 Sonography ofOther Neck Masses
Fig. 6.53 Vagal neurinoma
(TU) of the right neck, level
IV.CCA common carotid
artery, IHM infrahyoidal
muscles, IJV internal jugular
vein
127
Fig. 6.54 Large metastasis
(TU) of a squamous cell
carcinoma next to the internal
jugular vein (vji) and the
common carotid artery (acc).
SCM sternocleidomastoid
muscle
sonography. Then changes in this area such as skull base
metastasis, rare tumors like brous tumors (Fig. 6.57), or
even an aneurysm of the internal carotid artery (Fig.6.58)
can be detected with ultrasound. Furthermore, jugular vein
thrombosis as a cause of neck swelling can be diagnosed
very quickly by ultrasound (Video 6.9). All of these tumors
appear as hypoechoic lesions.
Even if other imaging methods are needed for complete
detection of the tumor extension, ultrasound can give us
important initial information about the origin of these tumors
or the existence of signs of malignancy (Figs. 6.59, 6.60,
6.61, and 6.62). Therefore, ultrasound should routinely be a
part of the clinical examination of patients suffering from
swelling in the head and neck region.
128
P. J e ck er
a
b
Fig. 6.55 Ectopic thyroid tissue (TU) in the oor of the mouth (a) and lateral to the thyroid cartilage (TC) (b). Sometimes thyroid tissue in the
neck is due to a large pyramidal process (c). CCA common carotid artery, HY hyoid
6 Sonography ofOther Neck Masses
129
Fig. 6.55 (continued)
c
Fig. 6.56 Cystic lesion
(arrow) within the thyroid
cartilage (TC). HY hyoid,
IHM infrahyoidal muscles.
Inset shows the corresponding
CT scan
130
Fig. 6.57 A rare case of a
solid brous tumor (TU) of
the skull base next to the
vertebral column (VC)
P. J e ck er
Fig. 6.58 Swelling of the
right neck caused by a
thrombosed aneurysm
(arrows) of the internal
carotid artery (ICA). Tumors
of the skull base can be
detected more easily if an
abdominal array is used. Inset
shows CT scan of the
aneurysm (from [10])
6 Sonography ofOther Neck Masses
Fig. 6.59 Intraosseous tumor
(TU) destroying the zygoma
(ZY). Histological
examination revealed a Ewing
sarcoma. Inset shows CT scan
of the zygoma
131
Fig. 6.60 Metastasis (TU) of
a squamous cell carcinoma
inltrating the clavicle (CL)
132
Fig. 6.61 Cancer (TU) of the
external auditory canal.
Tumor growth can also be
detected preauricular next to
the zygoma (ZY)
P. J e ck er
Fig. 6.62 Mastoiditis with a
subperiosteal abscess (AB).
MA mastoid
6 Sonography ofOther Neck Masses
133
6.6 Posttraumatic Changes
6.6.1 Hematoma andSeroma
Most posttraumatic changes involve fractures and hematoma. Fractures such as those of the nose or the mandible
are described elsewhere in this book. A hematoma can
Fig. 6.63 Hematoma (HE)
after nasal trauma, without
clotting. NB nasal bone
commonly be detected as a capsulated process without
vascularization. If the hematoma is not clotted, it appears
nearly echo-free with an acoustic enhancement (Fig.6.63).
If the hematoma is clotted, it appears hypoechoic but
commonly not echo-free (Fig. 6.64). Extended hematomas can be detected easily, but the detection of small
hematomas requires much more experience (Fig. 6.65).
Fig. 6.64 Spontaneous,
partially clotted hematoma
(HE) of the neck after massive
intake of anticoagulants
134
Fig. 6.65 Residual
hematoma (HE) of the neck
caused by a seat belt, after a
car accident
P. J e ck er
swabs has been described, but we have little experience with
such foreign bodies.
Fig. 6.66 Small seroma (arrows) after neck surgery. PG parotid gland
Neck seroma typically appears as a postoperative complication (Video 6.10). Usually it exposes itself as a
hypoechoic structure (Fig.6.66). In rare cases it can be
hyperechoic (Fig.6.67).
6.6.2 Foreign Bodies
Foreign bodies like a drain or a catheter (see Video 6.9) can
be detected with ultrasound. For example, they may appear
as small, hyperechoic structures with acoustic shadow
(Fig.6.68). The detection of foreign bodies such as bullets or
6.7 Sonographic Changes After Surgery
or Radiotherapy
After surgery, the anatomy of the neck may differ from the
normal situation. Therefore, the examiner is well advised to
know which surgical procedures were performed prior to the
ultrasound examination to avoid a false diagnosis. For example, after neck dissection, typical landmarks can be absent
(Fig.6.69), such as muscles, blood vessels, or salivary glands.
After laryngectomy, the neopharynx (Video 6.11) typically
can be seen between the large vessels of the neck (Fig.6.70).
In case of uncertainty, the neopharynx can be detected while
swallowing [2]. Furthermore, after radiotherapy of the neck,
the whole neck tissue is thickened owing to lymphedema
(Fig. 6.71) (Video 6.12). In this case, the whole picture
appears more hyperechoic because of the tissue edema.
The examination of the former tumor region is difcult.
For example, after reconstruction procedures with a forearm
ap, as shown in Fig. 6.72, it is possible to distinguish
between the ap and the surrounding tissue, because the ap
is characterized by a typical muscular echo. But the early
detection of recurrent cancer requires a very experienced
examiner, and one is well advised to perform other imaging
techniques as well, such as CT or MRI scans, during follow up or if other rare postoperative changes are seen (Fig.6.73).
6 Sonography ofOther Neck Masses
Fig. 6.67 Large seroma of
the neck (RF) around the
sternocleidomastoid muscle
(SCM) after neck dissection
and radiotherapy. Note the
strong relative enhancement
of the echo. CCA common
carotid artery, IJV internal
jugular vein
135
Fig. 6.68 Internal jugular
vein (VJI) catheter (PORT).
Note the reverberation
artifacts caused by the
foreign body and the acoustic
shadow (between arrows);
ACCcommon carotid artery,
SD thyroid gland, TRA
trachea
Fig. 6.69 Floor of the mouth
after neck dissection
including removal of the
anterior portion of the left
digastric muscle. DIG right
digastric muscle
136
Fig. 6.70 Neopharynx
(between arrows) after
laryngectomy. CCA common
carotid artery, IJV internal
jugular vein
P. J e ck er
Fig. 6.71 A distinct edema
(ED) of the oor of the mouth
after radiotherapy. DIG
digastric muscles, MHM
mylohyoid muscle