E1402. Pearls and Pitfalls of Head and Neck Oncologic Imaging
  1. Brandi Marsh; SUNY Downstate Medical Center
  2. Prajkata Bhimalli; SUNY Downstate Medical Center
  3. Zerwa Farooq; SUNY Downstate Medical Center
  4. Neha Doshi; SUNY Downstate Medical Center
  5. Vamsikrishna Kunam; SUNY Downstate Medical Center
  6. Vinokumar Velayudhan; Kings County Hospital; SUNY Downstate Medical Center
The purpose of this exhibit is to review key findings (pearls) and some common pitfalls encountered in imaging specific head & neck tumors. Recognition of subtle and sometimes benign-appearing findings facilitates early diagnosis, proper staging and management.

Educational Goals / Teaching Points
Cases will be presented in a quiz format. We will review classic head and neck tumors, patterns of spread, and lymphadenopathy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will discuss nasopharyngeal and oropharyngeal cancer. Key imaging findings in oral cavity cancer include absence of the midline lingual septum, suggesting tongue cancer. The puffed cheek technique is ideal for better evaluation of oral mucosa. For laryngeal cancer, we will review the pre-epiglottic and paraglottic space and discuss transglottic tumors. We will discuss features suggesting malignant thyroid nodules, including rapidly enlarging nodules and recurrent laryngeal nerve palsy. We will discuss classic findings in select skull base tumors, including juvenile nasopharyngeal angiofibroma (origin at sphenopalatine foramen) and esthesioneuroblastoma (marginal cysts). We will review tumor spread along contiguous spaces, perineural tumor spread, bony and cartilaginous involvement, and vessel encasement. In regard to lymphadenopathy, we will discuss cystic lymphadenopathy, which should not be mistaken for congenital cysts in adults. Lastly, we will review patterns of lymphadenopathy in specific malignancies, including nasopharyngeal cancer, cutaneous malignancy, and lymphoma.

Recognizing key imaging findings in head and neck tumors, which may be subtle, plays a major role in accurate diagnosis and facilitates appropriate and timely treatment.