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PEDIATRIC HEAD AND NECK MASSES: INTERVENTIONAL RADIOLOGICAL MANAGEMENT . WILLIAM E. SHIELS II , D.O. Chairman Children’s Radiological Institute and Department of Radiology Children’s Hospital Columbus, Ohio. GOALS Provide imaging management update Diagnostic imaging approach

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pediatric head and neck masses interventional radiological management
PEDIATRICHEAD AND NECKMASSES:INTERVENTIONALRADIOLOGICALMANAGEMENT
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WILLIAM E. SHIELS II , D.O.ChairmanChildren’s Radiological Institute andDepartment of RadiologyChildren’s HospitalColumbus, Ohio
pediatric head and neck
GOALS

Provide imaging management update

Diagnostic imaging approach

Current state of the art

Interventional Radiology Dx role

Therapeutic options

Pediatric Head and Neck
pediatric head and neck1
FOCUS

Congenital

Inflammatory

Neoplastic

Benign

Malignant

PediatricHead and Neck
juvenile nasal angiofibroma
Highly vascular tumor-benign

Male predilection, 7-21 yrs

Often present with epistaxis

Nasopharynx, max/sphenoid sinuses

CT +Contrast for Diagnosis

Embolization prior to surgery

Juvenile Nasal Angiofibroma
cervical adenitis
Non-suppurative

Sonography for diagnosis

Suppurative- neck abscess

US guided drainage

US guided Bx, FNA

Esp. cat scratch, mycobacterial

Cervical Adenitis
complicated neck abscess
Not acute emergency

May compromise airway

Bacterial: Grp A. Strep; Staph

CT best to diagnose, Sono to Tx

Dissects laterally, up, down

May dissect to mediastinum extrapleural

Complicated Neck Abscess
branchial cleft cyst
Branchial cleft remnants

Second BC most common

Cysts, sinuses, fistulae

Same course to tonsillar fossae

Unilocular cyst, +/- infection

US or CT/MR for diagnosis

Successful percutaneous ablation

Branchial Cleft Cyst
vascular malformations
Venous and lymphatic malformations

Slow flow

MRI and US (pre-treatment)

Arteriovenous malformations

High flow, no ST mass

MRI, angiography (pre-treatment)

Vascular Malformations
lymphatic malformation
Lymphatic ductal malformation

Posterior triangle most common

Any space in neck, shoulder,

Mediastinum, may invade airway

Macrocystic (hygroma), microcystic

Non-operative treatment +/- successful

Lymphatic Malformation
mechanism
DETERGENT (Sotradecol)

Opens cellular channels

Lipoprotein membrane

ETHANOL

Denatures proteins

Cell destruction

Inflammatory response

MECHANISM
locations types
LOCATIONS

Neck

Face (including parotid bed)

Orbit (retrobulbar) -

TYPES

Macrocystic

Microcystic

LOCATIONS / TYPES
us guided puncture
US guided puncture

5 F Pigtail

Complete aspiration

ranula
•Cystic mass-salivary glands

Sublingual, submandibular, parotid

Dilated ducts…to…..massive cysts

Intraparenchymal cystic collections

Huge “diving” ranulas in neck spaces

RANULA
plunging ranula
Pseudocyst

Sublingual, submandibular most common

Treat infection

Drain cystic collection: Mucous

Sclerose cavity

Regional ablation of salivary gland

PLUNGING RANULA
simple ranula1
•Cystic mass-salivary glands

Sublingual, submandibular, parotid

Dilated ducts…to…..large cysts

Intraparenchymal cystic collections

Usually rupture into mouth, decompress

Tx: Percutaneous ablation first line therapy

Surgical resection if ablation fails

SIMPLE RANULA
epidermoid dermoid
Cystic mass-head and neck

Developmental origin

Lines of embryonic suture closure

Periorbital, anterior neck, nose, scalp

Lined-keratinizing squamous epithelium

Contain epithelium, sebum, debris

Percutaneous ablation now an option

EPIDERMOID/DERMOID
case hx
13 mo male

H/o fall from Powerwheel

Face first, left eye trauma

Periorbital cellulitis

T= 103oF

CASE HX
pediatric head and neck masses
CONCLUSION

Brief summary- common concerns

Pathologic understanding

Practical issues

Imaging management rationale

Therapeutic intervention options

Pediatric Head and Neck Masses