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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5770_Библиотеки_им_академика_М_И_Перельмана.pdf
7 Sonography oftheOropharynx, Hypopharynx, Larynx, andCervical Esophagus
Fig. 7.16 T4 cancer of the
left tonsil (TO). LN reactive
lymph node, SM
submandibular gland
147
Fig. 7.17 Cancer of the right
tonsil (TO) with inltration of
the mouth oor and the
submandibular gland (arrows)
148
Fig. 7.18 Malignant
lymphoma of the right tonsil
(TO) with multiple lymph
nodes (LN) in the neck. SM
submandibular gland
P. J e ck er
a
Fig. 7.19 (a) Non-Hodgkin lymphoma of the left tonsil. (b) The diagnosis is supported by the typical pattern of lymph nodes (LN) next to the
submandibular gland. SM submandibular gland, TO tonsil
7 Sonography oftheOropharynx, Hypopharynx, Larynx, andCervical Esophagus
b
Fig. 7.19 (continued)
a
149
b
Fig. 7.20 T4 cancer of the right tonsil (TO) (a) and the pharyngeal wall (PW) (b) with metastatic lymph nodes (LN). ACC common carotid artery,
SCM sternocleidomastoid muscle, SM submandibular gland, THY thyroid
150
P. J e ck er
a
b
Fig. 7.21 (a) Recurrent cancer (TU) next to the pharynx and the carotid artery (ac). (b) Using pulsed-wave (pw) Doppler, the internal carotid
artery can be identied next to the tumor
7 Sonography oftheOropharynx, Hypopharynx, Larynx, andCervical Esophagus
151
7.2 Tumors oftheTongue Base
andtheVallecular Region
Similar to tonsillar hyperplasia, hyperplasia of the tongue
base is frequently seen clinically. Using ultrasound, the
tongue base is hypoechoic, and its size is symmetrical on
both sides (Fig.7.22; Video 7.3). Unilateral enlargement of
the tongue base can be well documented with ultrasound
(Figs. 7.23 and 7.24). Furthermore, tumors of the tongue
a
base (Fig.7.25) and even the extent of thyroid tissue at the
tongue base (Figs. 7.26 and 7.27) can be estimated with
ultrasound. But of course, the correct diagnosis always
depends on the clinical aspect, because many pathologies in
this region show a similar sonographic appearance.
Similar to the tongue base, the vallecular region is sometimes difcult to inspect during clinical examination.
Depending on the patient’s neck anatomy, pathologies of
this region can be visualized by ultrasound on both sides
b
Fig. 7.22 Symmetric hyperplasia of the tongue base (arrows). (a) Frontal plane. (b) Two sagittal planes beside the midline. MF mouth oor,
TO tongue
152
Fig. 7.23 Moderate
hyperplasia of the left tongue
base (arrow). MF mouth oor,
TO tongue
P. J e ck er
Fig. 7.24 Massive
hyperplasia of the left tongue
base (arrow). MF mouth oor,
TO tongue
7 Sonography oftheOropharynx, Hypopharynx, Larynx, andCervical Esophagus
Fig. 7.25 T1 cancer of the
left tongue base (RF). The
image shows both sides of the
tongue base in an oblique
plane and the intraoperative
situs (inset). DIG digastric
muscle, SM submandibular
gland, ZU tongue
153
ba
Fig. 7.26 Goiter (TU) of the tongue base in a frontal plane (a) and a sagittal plane (b). HY hyoid, MF mouth oor, TO tongue
154
Fig. 7.27 Goiter (TU) of the
tongue base, hypoechoic. HY
hyoid. Inset shows
corresponding MRI
P. J e ck er
Fig. 7.28 Vallecular cyst
(TU) visible between the
hyoid (ZB) and the thyroid
cartilage (SK). ZG tongue
base
next to the acoustic shadow of the hyoid (Figs.7.28 and
7.29). We detect mainly vallecular cysts in this region
(Video 7.4). These cysts are commonly hypoechoic, with a
relative signal enhancement. It is impossible to differentiate
this cyst from an epiglottic cyst (Fig.7.30) based only on
ultrasound.
7 Sonography oftheOropharynx, Hypopharynx, Larynx, andCervical Esophagus
Fig. 7.29 Small vallecular
cyst (CY). HY hyoid, MF
mouth oor, TO tongue base
155
Fig. 7.30 Large epiglottic
cyst (CY). MF mouth oor,
TO tongue base
156
P. J e ck er
7.3 Tumors oftheLarynx
Laryngeal tumors are detectable via endoscopic examination.
Ultrasound of these tumors is difcult because major tumor
parts often are located within the organ. It also becomes more
difcult to view intralaryngeal structures with increasing age
of the patient, owing to greater calcication of the cartilages.
Nevertheless, the examiner should always try to detect the
tumor using ultrasound because major interindividual differences exist in the calcication of the cartilages [4].
Additionally, other single structures like the epiglottis or the
hypopharynx also can be evaluated with ultrasound.
Fig. 7.31 Acute epiglottitis
(EP) with swelling of the left
side, sagittal plane (a) and
frontal plane (b). HY hyoid,
MF mouth oor, TO tongue
base
a
Epiglottic changes can be seen through a sonographic window between the hyoid and the thyroid cartilage (Fig.7.31).
Parts of the epiglottis might be overlapped by the acoustic
shadow of the hyoid, however, making the detection of small
tumors impossible. Similarly, processes of the larynx can be
seen with ultrasound in cases of extralaryngeal growth, such
as external laryngoceles (Fig. 7.32) or even larynx cancer
inltrating supraglottic structures or the tongue base
(Fig. 7.33). If such processes are detected with ultrasound,
typical benign characteristics, such as homogeneity and regular margins (Fig.7.32), or malignant characteristics like heterogeneity and irregular margins (Fig.7.33) become visible.
b