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Site. Size. Measuring the dimensions in cm Describing boundaries (the lesion extends from…..to …..in one dimension and extends from…..to ……in the other dimension). Site Size Shape Outline Relative density Effects on adjacent surrounding structures. Shape. Monolocuar.

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Presentation Transcript
slide1

Site

Size

  • Measuring the dimensions in cm
  • Describing boundaries
  • (the lesion extends from…..to…..in one dimension
  • and extends from…..to……in the other dimension)

Site

Size

Shape

Outline

Relative density

Effects on adjacent surrounding structures

slide2

Shape

Monolocuar

  • Monolocular/unilocular
  • Multilocular
  • Pseudoloculated
  • Round
  • Oval
  • Scalloped/undulating
  • Irregular

Pseudolocuar

Multilocuar

slide3

Outline

*Well-defined

  • Smooth
  • Punched-out
  • Corticated: a thick or

thin surrounding RO line

  • Sclecotic: a non-uniform

RO boundary

  • Oval
  • Encapsulated
  • Irregular

Well-defined

with a corticated

margin

Well-defined

without a corticated

margin

Poorly-defined

*Poorly-defined

slide4

Effects on adjacent

surrounding structures

Relative density

  • Bony expansion

2. Displacement ID canal

3. Thinning of cortex

  • Uniformly RL
  • RL with RO (mixed)
  • RO
  • Tooth displacement
slide5

www.dent.ucla.edu/sod/depts/oral_rad/courses/DS422b/

Question:

Please describe the lesion

as indicated by

yellowish arrow

There is a well-defined unilocular round shaped circumcoronal radiolucence with corticated margin over the submerged tooth 38 extending from left retromolar area down to the mandibular angle and from distal aspect of tooth 37 up to two/thirds of left ramus area, measuring approximately 3  5 cm in diameter.

slide6

A sequential approach to radiological interpretation

Panoramic radiography revealed the patient to be fully

edentulous. All bony outlines were within the normal range

except for a 4.5 x 3.0 cm well-demarcated, unilocular

homogeneous radiolucency with smooth well-corticated

outline in the left body of the mandible.

The lesion extended from the premolar region back to 1.5 cm

anterior to the posterior margin of the mandibular ramus.

There was slight expansion of the cortical outline of the lower

border in the left antigonial notch region.

slide7

A sequential approach to radiological interpretation

The adjacent mandibular canal was inferiorly displaced. Canal cortical outlines were intact with no evidence of resorption and the paranasal sinuses were clear.

A root fragment was noted in the region of the radiolucency in the left mandible, and there were several areas of the well-

delineated radiolucency in the left mandible was that of a benign cyst or tumor.

slide8

A sequential approach to radiological interpretation

Panoramic radiography alsorevealed a well-delineated

radiolucency rimmed by an ovoid 3.5 x 2.5 cm calcified

margin, superimposed over the left mandibular ramus.

The radiographic shadow of the calcified soft tissue lesion

extended superiorly to the level of the mandibular sigmoid

notch and 1.5 cm below the head of the left mandibular

condyle, and inferiorly to 1 cm below the left mandibular

foramen and lingula

slide9

A sequential approach to radiological interpretation

The principal differential interpretations were carotid

aneurysm and calcified lymph node.

Although carotid bruit was not clinically detected, the risk of

a carotid aneurysm mandated prompt investigation of this

radiographic finding.

To elucidate further the position of this calcified soft-tissue

lesion and the boundaries of the mandibular radiolucency, an

axial CT examination was performed.

slide10

Axial CT

Axial CT

Axial CT

Maxilla

1st cervical vertebra

A sequential approach to radiological interpretation

The CT confirmed the presence of the calcified-rimmed soft

tissue ventral and lateral of the first cervical vertebral body

and skull base.

This was interpreted as compatible with aneurysm or

psedoaneurysmal dilation of the internal carotid artery,

measuring as large as 2.4 cm.

Degenerative changes in the cervical spine were noted.

slide11

Axial CT

Axial CT

Mandible, lower portion

Mandible, upper portion

A sequential approach to radiological interpretation

Lower CT slices through the body of the mandible confirmed

the homogeneously radiolucent cystic lesion with a benign

appearance. There was evidence of buccal and lingual cortical

expansion with attenuation.

In view of the report of a probable carotid aneurysm,

CT angiography was prescribed to relate this lesion to its

surrounding structures.

slide12

A sequential approach to radiological interpretation

CT angiography revealed the calcified mass was intimately

related to tortuous internal and external carotid arteries.

Careful reformatting at various angulations failed to demonstrate a direct continuity between the internal carotid and the presumed aneurysm; however due to structural superimposition CT failed to provide a definite answer.

MRI was selected to elucidate further structures

obscured in the CT angiograms.

slide13

A sequential approach to radiological interpretation

MRI revealed bright signals for the carotid artery and jugular veins

bilaterally, but failed to demonstrate an aneurysm.

The contents of the lesion in the left mandibular body had intermediate signal intensity

slide14

A sequential approach to radiological interpretation

Angio MaxIP MRI revealed the carotids were found to be

tortuous. There was no evidence of an aneurysm of the left

internal carotid artier.

The surgeon wanted additional verification of the absence of

a carotid aneurysm and ordered ultrasonography.

slide15

A sequential approach to radiological interpretation

Ultrasound images showed no evidence of aneurysm. Both

carotid bifurcations were tortuous. There was evidence of

atherosclerotic plaque in the left and right carotid bifurcation

bulbs and the proximal region of the left internal carotid artery.

The systolic velocity ratio of right internal to common

carotid artery was 0.59 whereas the diastolic velocity ratio was

0.78; for the left side the respective ratios were 0.96 and 1.47.

These ratios are within the normal range.

slide16

A sequential approach to radiological interpretation

Final Diagnosis

Mandibular lesion

Glandular odontogenic cyst

Neck lesion

The calcified lesion in the soft tissues adjacent to the first

cervical vertebra and extending to the carotid space was not

a carotid aneurysm, but rather a calcifying ‘cystic’ mass

probably representing a lymph node.