ct neck anatomy radiology ppt

A good book to refer to when you are reporting CT and MR. All images are accompanied by line diagrams which makes it easy to understand. CT scan allows the radiologist to view the different levels or slices of the skull bone’s temples or side. Surgical drainage was performed. (c) Sagittal nonenhanced CT image (bone window) shows calcification (arrow) inferior to the anterior arch of C1, in the typical location for calcific tendinitis of the longus colli. Infiltration of the periantral fat is a classic finding of acute invasive fungal sinusitis (Fig 18) (58). Do we need a change in ED diagnostic strategy for adult acute epiglottitis? A peritonsillar abscess (PTA) or peritonsillar phlegmon develops following tonsillitis or pharyngitis and is the most common pediatric head and neck abscess (20). In patients with pneumatized petrous apices, petrous apicitis, a condition analogous to mastoiditis, can develop in the petrous apex (61). 5 0 obj Axial nonenhanced CT images show the radiodense bone (black arrows) in the cervical esophagus, posterior to the larynx. Furthermore, although the patient may present because of symptoms that suggest non–life-threatening conditions involving structures such as the teeth or salivary glands, there may be serious implications for other areas, such as the orbits, brain, and spinal cord, that also may be revealed at the examination. Graves disease is the most common autoimmune disease and the most common cause of hyperthyroidism. If there is an obstructing ductal stone (Fig 14), ductal dilatation also is present. (b) Axial contrast-enhanced CT image obtained inferior to a shows continued extension into the mediastinum (white arrow) and a small left pleural effusion (white arrowhead). The findings in this case show that minimal sinus opacification does not exclude the diagnosis of invasive fungal sinusitis. ■ Compose a report detailing and synthesizing the findings seen at emergency neck CT. Symptoms may develop over minutes to hours and resolve over 1–3 days. When possible, a PTA should be differentiated from an intratonsillar abscess, which may not require drainage and is associated with a lower recurrence rate (22). Therefore, we recommended documenting the distance from the closest margin of the abscess to the carotid artery and whether there are any trajectories that are particularly safe or unsafe if an intraoral drainage is performed. Axial contrast-enhanced CT image shows enlarged palatine tonsils (arrows) that are in contact with each other (“kissing” tonsils) at the midline. Nodal metastasis is a common feature of squamous cell carcinoma of the head and neck. Radiology of Nasal Cavity and Paranasal Sinuses Radiology XRAY CT MRI Normal Anatomy Drainage system Lamella: 1) uncinate 2) ethmoidal bulla 3) basal lamella 4) superior turb lamella Uncinate attachment variations Agger Nasi Frontal sinus outflow tract May be narrowed by agger anteriorly or bulla posteriorly Frontal cells (Type 1-4) Frontal recess Lateral: lamina papyracea Medial: … ... ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Left petrous apicitis in an 11-year-old girl who presented with ear drainage and diplopia. Axial contrast-enhanced CT images show opacification of the frontal sinuses (* in a) and a rim-enhancing epidural fluid collection (black arrow in b) just superior to the frontal sinus, which is consistent with an epidural abscess. At CT, this condition appears as a soft-tissue–attenuation tract between the tooth apex and the sinus, with adjacent opacification of the sinus (Fig 9). (a) Axial contrast-enhanced CT image (bone window) shows left tympanomastoid opacification (*), as well as opacification and coalescence of air cells at the petrous apex (white arrow). Epiglottitis is now more commonly seen in adults, with an incidence of one to two cases per 100 000 adults, as a result of other bacterial (Streptococcus pneumoniae), viral (herpes simplex), and fungal infections, or noninfectious causes such as trauma or chemicals (17,18). Retropharyngeal abscess is an accumulation of pus posterior to the pharynx, with the potential to spread inferiorly into the mediastinum via the “danger” space. In Lemierre syndrome, septic thrombophlebitis of the internal jugular vein occurs secondary to a pharyngeal infection such as pharyngitis or PTA (Fig 17). Normal Neck. If the infected nodes rupture, a retropharyngeal abscess forms. Also, when the carotid artery has a medial course, this variant should be noted because it may be mistaken clinically for tonsil-related disease, or the artery may be injured in a tonsillar intervention (23). Under normal circumstances, the superior mediastinal fat should be homogeneous, without fat stranding or a pneumomediastinum. Knowledge of normal anatomy is the cornerstone for understanding pathologic processes. (a, b) Acute right submandibular sialadenitis in a 57-year-old woman. Retropharyngeal edema due to calcific tendinitis of the longus colli in a 71-year-old woman. Ultrasound of the Neonatal spine; Unsorted. The oral cavity (black * in b) is obliterated. MRI is useful for evaluating intracranial extension of mastoiditis. Comparing the side of the clinical symptoms with the contralateral side can be helpful in determining whether there is erosion of the mastoid septa. The pneumatized spaces of the head and neck include the paranasal sinuses, which communicate with the nasal cavity, and the mastoid air cells, which communicate with the tympanic (middle ear) cavity. W-Radiology discusses how medical imaging methods visualize the inner body structures to help diagnose and treat diseases. When it is infected, the wall thickens and demonstrates contrast enhancement, and surrounding inflammatory fat stranding develops (12). Internal cysts and a calcification also are noted. Cavernous sinus thrombosis is seen occasionally. The thyroid gland synthesizes the hormones triiodothyronine and thyroxine. Pocket Atlas of Sectional Anatomy. Epidural phlegmon in a 59-year-old man with human immunodeficiency virus infection and a history of intravenous drug use. The orbits are included in all CT examinations of the neck. Anatomy. *1 J�� "6DTpDQ��2(��C��"��Q��D�qp�Id�߼y�͛��~k��g�}ֺ ��LX ��X��ň��g`� l �p��B�F�|،l�� *�?�� Y"1 P��\�8=W�%�Oɘ�4M�0J�"Y�2V�s�,[|��e9�2��s��e��'�9��`��2�&c�tI�@�o�|N6 (��.�sSdl-c�(2�-�y �H�_��/X��Z.$��&\S��M��07�#�1ؙY�r f��Yym�";�8980m-m�(�]��v�^��D��W~� ��e��mi ]�P��`/ ��u}q�|^R��,g+��\K�k)/��C_|�R��ax�8�t1C^7nfz�D��p�柇��u�$��/�ED˦L L��[��B�@��ٹ��ЖX�! Institutions, hospitals, and pr oviders may differ in their specific practices. Furthermore, mucosal thickening can persist for 8 weeks following the resolution of sinusitis (56). Degenerative disease of the cervical spine is commonly seen at neck CT and frequently incidental. The presence of degenerative changes should be noted, at least in general terms, and if severe spinal canal stenosis or an alignment abnormality is present, a more detailed description is warranted. Axial contrast-enhanced CT images show opacification of the frontal sinuses (* in a) and a rim-enhancing epidural fluid collection (black arrow in b) just superior to the frontal sinus, which is consistent with an epidural abscess. neck. Figure 10a. Septic pulmonary emboli should be included in the “Lung Apices” section. Adobe Flash Player is required to view the web-based format. There are a myriad of head and neck pathologies that extend from the extracranial to the intracranial compartment, traversing the skull base, and knowledge of the imaging appearance of this pathology is critical to practicing neurosurgeons. CT of the neck enables definitive identification and localization of potential foreign bodies. Findings of pulmonary edema include interlobular septal thickening and nodular or confluent ground-glass opacities, which are often accompanied by pleural effusions (Fig E12). The most commonly implicated drugs are angiotensin-converting enzyme inhibitors (either immediate or after months to years of taking the drug) and nonsteroidal anti-inflammatory agents (28). I am a radiology physician from California, USA. View and Download PowerPoint Presentations on Ct Brain Anatomy PPT. CT of the neck is a study of the neck region from the skull base (bottom of the head) to the lung apices (top of the chest). Iodine deficiency is an important cause of goiter worldwide, but it is uncommon in the United States. View all posts by radiologypics ». Children with epiglottitis generally are in respiratory distress when they present and are diagnosed at clinical or radiographic examination. However, the symptoms of cervical spine disease may mimic those of extraspinal entities, prompting the use of neck CT with a soft-tissue protocol. Other causes of goiter include Graves disease and toxic or nontoxic nodular goiter. If the superior ophthalmic vein is not thrombosed, it becomes enlarged owing to impaired drainage into the cavernous sinus (Fig 22). Figure 17c. Our goal is to help you improve your understanding of Head and Neck imaging and to empower you to provide the best of care to your patients. FIRST YEAR MOCK. This facilitates the understanding and interpretation of cross-sectional imaging modalities like CT and MRI (1). They measure up to 5 mm in diameter and, owing to their small size, generally are not well seen at routine CT of the neck (42). Jakab M., Kikinis R. Head and Neck Atlas. There is also thickening of the left platysma muscle (arrow). A neck mass or adenopathy also may be investigated, particularly when it results in airway or vascular compromise. Normal epiglottis versus epiglottitis in two patients. Three volumes covering imaging anatomy. Knowledge of this complex anatomy is necessary when a mass or inflammatory process is identified, and a strategy for determining which structures are deviated and the direction of the deviations must be used to make a diagnosis or differential diagnosis. Sialolithiasis with an obstructing ductal stone is an important cause of submandibular sialadenitis; 80%–90% of sialoliths occur in the submandibular glands, while 10%–20% occur in the parotid glands. There is coalescence of the right mastoid air cells (black arrow) with breakthrough of the overlying cortex (white arrow). At CT, the attenuation of the parotid gland in adults is usually intermediate, between the attenuation of fat and that of muscle, owing to its fat content. CT findings of the neck should be interpreted systematically, in a manner similar to that used to interpret other radiologic studies, such as abdominopelvic CT images and chest radiographs. The diagnosis of angioedema as the cause of head and neck swelling is usually based on clinical examination findings and the exclusion of other serious diagnoses. Otitis externa, also called swimmer’s ear, is a superficial infection of the external auditory canal (EAC) that is related to minor trauma or liquid exposure such as that from swimming. Figure 12. Ninety percent of cases of viral sialadenitis involve the parotid glands, while 10% also involve the submandibular glands (44). The danger space is a potential space that extends from the skull base to the diaphragm. Neck CT scan Protocols. Diffuse pharyngeal or laryngeal edema may be seen at CT, but it generally follows intubation, with the swollen soft tissues surrounding a previously placed endotracheal tube. {{{;�}�#�tp�8_\. (a) Axial nonenhanced CT image shows asymmetric soft-tissue thickening (white *) medial to the left mandibular ramus, as well as thickening of the left masseter muscle (black *). Typically, the area imaged at neck CT extends inferiorly as far as the aortic arch and therefore includes the superior mediastinum. Axial (a) and coronal (b) contrast-enhanced CT images show bilateral low-attenuation collections (arrows) superolateral to the palatine tonsils (* in b). A chronic form of invasive fungal sinusitis may occur in immunocompetent patients, in whom the condition progresses over months to years (57). At imaging, the epiglottis and aryepiglottic folds should be thin (Fig 2). There is usually bilateral involvement, which may lead to airway obstruction at the level of the oral cavity and oropharynx (4). In children and some adults, the parotid gland is isoattenuating to muscle. Sixty milliliters of iodinated contrast material is injected at 2 mL/sec for 30 seconds. Primary cellulitis of the subcutaneous tissues of the face may be caused by disruption of the skin due to chronic skin conditions (such as eczema and psoriasis), infection of a hair follicle (folliculitis), a retained foreign body, or minimal trauma. If there is diffuse disease, a general statement should be made and may be followed by a description of the worst one or two lesions. (b) Sagittal contrast-enhanced CT image shows a clot (arrow) in the left internal jugular vein. This means that the right side of the brain is on the left side of the viewer. At standard CT evaluation of the neck, the craniocervical junction and the entire cervical spine are included, and abnormalities of the cervical spine are commonly seen. Sialadenitis in two patients. Classroom Sessions. Figure 6c. A knowledge of these spaces not only allows for better communication between radiologists and specialists familiar with imaging of this region but also aid in diagnosis as each space has a distinct group of pathologies. Head and Neck Radiology . Bland thrombus is frequently associated with indwelling venous catheters, such as hemodialysis catheters, and can also be seen in thrombophilic conditions. Numerous veins are visible on contrast-enhanced neck CT images. Normal anatomy- plain film/ CT/MRI. For example, focal involvement may be seen in the tongue (Fig E5) (particularly in association with angiotensin-converting enzyme inhibitors), subcutaneous fat, lips (Fig 7), or soft palate, and it may be unilateral (28). Head and Neck Cases. Although classically thought of as a disease of children, epiglottitis also affects adults, being most famously the likely cause of the death of George Washington in 1799 (16). Ludwig angina, derived from the Latin word angere, meaning choke, refers to a polymicrobial infectious cellulitis involving the sublingual space above the mylohyoid muscle and the submandibular (ie, submylohyoid) space below the mylohyoid muscle. Axial nonenhanced CT images show the radiodense bone (black arrows) in the cervical esophagus, posterior to the larynx. There is also enhancing subgaleal soft tissue (white arrow), consistent with phlegmon. It is great for learning general anatomy or showing patients a normal CT scan for comparison. Note the tapered superior and inferior margins in b. CT scan of head and neck : Axial . Abstract. Classroom Sessions. Radiology basics of chest CT anatomy with annotated coronal images and scrollable axial images to help medical students and junior doctors learning anatomy. There is gas (white arrows in b) within the adjacent left lateral soft tissues, consistent with perforation. Descending mediastinitis in a 50-year-old woman who recently underwent a dental procedure. Note the tapered superior and inferior margins in b. Bacterial sialadenitis may be complicated by the formation of a rim-enhancing abscess or multiple small abscesses. The major salivary glands include the parotid, submandibular, and sublingual glands. Although a discussion of this topic, including characterization and workup, is beyond the scope of this review, this subject has been reviewed previously in this and other journals (36–38). Finally, important information regarding the fluid status of the patient can be gleaned from an assessment of the lung apices. High-resolution computed tomography (CT) and magnetic resonance imaging (MRI) have become indispensable tools for the evaluation of conditions involving the head and neck. « CT of the Chest Soft Tissue Windows Axial Anatomy. Important aortic disease can be detected incidentally at neck CT performed in the emergency department. In this situation, repeat CT with intravenous contrast material may be necessary to delineate an abscess. �@��R�t C��X��CP�%CBH@�R��f�[�(t� C��Qh�z#0 ��Z�l�`O8��28.��p|�O×�X Hydrocephalus. Malignant otitis externa is a life-threatening disease that is typically seen in elderly patients with diabetes, and it is caused by Pseudomonas aeruginosa infection in more than 90% of cases (8). Fungal sinus disease includes allergic fungal sinusitis and invasive fungal sinusitis. Numerous common and clinically significant pathologic conditions may be seen in the lung apices at neck CT. There is associated adjacent polypoid mucosal disease within the maxillary sinus (arrow). Images in: CT, MRI, Radiographs, Anatomic diagrams and nuclear images. (b) Sagittal contrast-enhanced CT image shows a clot (arrow) in the left internal jugular vein. Complications of mastoiditis include erosion of the outer cortex of the mastoid bone with development of a neck abscess (ie, Bezold abscess) (Fig 19), as well as erosion of the inner cortex of the mastoid bone, which can lead to sigmoid sinus thrombosis, epidural abscess, or cerebritis with or without brain abscess (60). Bony breakthrough occurs at weak points of the alveolar process, which include the buccal surface throughout the maxilla and the lingual surface in the area of the mandibular molars. Periodontal abscess in a 50-year-old man. The enlargement may be asymmetric (39). If left untreated, there may be subsequent spread into adjacent muscle and deep spaces of the neck. CTA - Head & Neck : View Reconstruction : Download PPT: 3D CTA : Unit 2 : View Abnormalities: Download PPT: Abnormalities: INSTRUCTIONS. (a) Axial nonenhanced CT image (bone window) shows an opacified left frontal sinus, with thinning of the posterior wall of the sinus (arrowhead). Subcutaneous edema (white arrowheads) also is present. Fistulization and drainage to the skin also may occur (Fig 15). Involvement of the periantral fat, orbits, or intracranial compartment indicates invasion (57). Neck CT. UQ Med Yr 1 GAF/Radiographic Anatomy - Head and neck. Impacted chicken bone in a 78-year-old woman. Peritonsillar phlegmon appears as a vague hypoenhancing area without a well-formed rim of enhancement. In keeping with lymphatic drainage patterns, the location of a nodal metastasis can suggest the site of a primary head and neck malignancy. We begin by describing a protocol for CT of the neck. In comparison, the left anterior wall of the left EAC (white arrowhead) is complete. Lemierre syndrome in a 15-year-old girl. Allergic fungal sinusitis is a chronic inflammatory condition that is characterized at CT by extensive opacification of multiple sinuses, which are typically expanded. However, the quality of the MR image can be compromised by motion artifacts as a result of breathing, swallowing, and vascular pulsations. If you need other dark templates you can download free black PowerPoint templates. In the acute phase, the lymph nodes are enlarged and homogeneously enhance at CT. As caseation occurs, the nodes become centrally hypoattenuating and cystic, with perinodal fat stranding that is milder than what is seen with bacterial adenitis (Fig 15). CT can depict a spectrum of tonsillar and peritonsillar abnormalities. Therefore, neck CT may be performed to rule out treatable diagnoses. Figure 2b. Systemic dissemination of infection may occur, particularly if treatment is delayed, and is associated with significant mortality, even with antimicrobial treatment (54). When decay reaches the pulp chamber of the tooth, the pulp becomes infected, pressurized, ischemic, and ultimately necrotic. Vascular clot or occlusion should be included in the “Vascular Structures” section. endobj However, in the setting of neck pain, degenerative disease may be relevant with regard to the symptoms reported by the patient. The classic striated enhancement pattern is seen in the right tonsil. However, a few points should be made to differentiate malignant adenopathy from infectious adenopathy. Therefore, when a soft-tissue abnormality is detected in the EAC, adjacent bone, soft tissue, and intracranial structures should be examined for the possibility of contiguous spread. How to Read a Neck CT. Head and Neck Anatomy. Another lymph node (white arrow) has ruptured and fistulized to the skin. This section of the website provides medics with a huge library of free Radiology PPT templates with topics like MRI, CT Scan, Medical Imaging, X-Ray and many other Radiology concepts and themes. Right coalescent mastoiditis with extracranial abscess in a 13-year-old girl. As mastoiditis progresses, the mastoid septa become eroded. In the setting of suspected cervical spine disease, dedicated CT or MRI of the spine is preferred over neck CT. Unique vertebra. Figure 13. The presence and extent of nodal metastases in head and neck cancer has a great impact on treatment and prognosis. Axial contrast-enhanced CT image shows a centrally hypoattenuating cystic lymph node (black arrow) with minimal surrounding fat stranding. In comparison, the right parotid gland (black arrowhead) is normal. Radiology department of the University Medical Centre of Utrecht and the Alrijne Hospital in Leiderdorp, the Netherlands. The subcutaneous tissues may be the primary site of inflammation or an indication of adjacent inflammation. The presence of supportive clinical features, such as tenderness over the mastoid prominence of the temporal bone, is required for diagnosis. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Acute invasive fungal sinusitis typically occurs in immunocompromised patients and can be rapidly progressive and life-threatening (57). It is most often performed in the helical mode. In fact, contrast material may obscure or confound the detection of a small foreign body. (b) Image in a obtained in soft-tissue windows shows epidural phlegmon (white arrow) and nonenhanced foci (black arrows), consistent with abscess. Pediatric Chest CT. Nonvascular Mediastinal Masses; Pediatric Chest CT 2; Spine. Ludwig angina is one of the most feared complications of dental infection. There is also enhancing subgaleal soft tissue (white arrow), consistent with phlegmon. Figure 1a. Imaging of Petrous bone part 2 ( Pathology ) - Dr Mamdouh Mahfouz. Cranial nerves V, VI, and IX–XII also may be affected as infection spreads in the soft tissues (7). (a) Axial contrast-enhanced CT image (bone window) shows left tympanomastoid opacification (*), as well as opacification and coalescence of air cells at the petrous apex (white arrow). (c) Coronal contrast-enhanced CT image at the level of the parotid glands in a 22-year-old woman with acute left parotiditis shows edema, enlargement, and hyperenhancement of the left parotid gland (white arrowhead). The last category of dental infection is pericoronitis, in which food material becomes trapped under a gum flap, commonly in the setting of a partially erupted third molar, and causes acute inflammation and infection (Fig E9). Infection may spread into the periodontal or more distant tissues as a result of dental procedures such as tooth extraction (33). There is also thin enhancing material in the anterior epidural space extending from the C1–C5 vertebrae (arrows), consistent with epidural phlegmon. Left frontal sinusitis and left frontal lobe abscess in a 22-year-old man. As a last point, either clinical or imaging follow-up or tissue sampling may be necessary to make a definitive diagnosis. However, owing to associated edema, as in this case, this may not always be possible. The two superior parathyroid glands are most commonly located dorsal to the superior poles of the thyroid gland, and the two inferior parathyroid glands are most commonly located inferior, dorsal, or lateral to the inferior thyroid pole (42). The thyroid normally enhances homogeneously following intravenous contrast material administration. Mycobacterial lymphadenitis (scrofula) in the left side of the neck in a 43-year-old man. This means that the right side of the brain is on the left side of the viewer. Stichting Radiology Assistant - ANBI; Information; Apps. Figure 22. These findings were confirmed at contrast-enhanced MRI (not shown). However, large anterior osteophytes, as seen in the setting of diffuse idiopathic skeletal hyperostosis, can cause dysphagia owing to compression of the esophagus (64). Gross anatomy. Pathology seen on different imaging modalities. Arterial dissection is characterized by a defect in the intimal layer of the artery that allows passage of blood into the arterial wall. The advent of CT and MRI allowed radiologists to better visualize the complex anatomy and pathology of the suprahyoid neck. >> Periodontal abscess in a 50-year-old man. There is associated subcutaneous edema (white arrowheads) of the face and edema in the left orbit. Under supervision of Dr / Mamdouh Mahfouz. Please see disclaimer on my website. Online supplemental material is available for this article. %�� Let’s start with black. Complications of acute bacterial sinusitis include extension into the orbit with development of a subperiosteal abscess and orbital cellulitis; extension into the overlying soft tissues (eg, Pott puffy tumor); and intracranial extension with development of an epidural abscess, subdural empyema, or cerebritis with or without brain abscess. Although many of these conditions are identified incidentally, recognizing them can still be vital for patient management. Pneumonia appears as nodular and/or consolidative opacities in the lung parenchyma. University Hospitals Bristol. Sino-nasal Imaging - Dr Mamdouh Mahfouz. ?��:��0�FB�x$ !��i@ڐ��H��[EE1PL��⢖�V�6��QP��>�U�(j Routine scanning of the neck is typically performed with the patient supine and the neck slightly extended. sequential imaging in the axial plane with each section measuring 5 mm thick Helical imaging is used for CT angiograms of the head/neck and other parts of the body . Presented as an education exhibit at the 2018 RSNA Annual Meeting. The diagnosis of Lemierre syndrome (discussed earlier) is used to illustrate this synthesis process (Figure E15). This tutorial takes you through the important anatomy required to understand CT images of the brain. Owing to the lack of contrast enhancement, an abscess cannot be discerned. (c) Coronal contrast-enhanced CT image at the level of the parotid glands in a 22-year-old woman with acute left parotiditis shows edema, enlargement, and hyperenhancement of the left parotid gland (white arrowhead). In comparison, the right internal carotid artery (arrowhead) is normal. Furthermore, the correlation between the ct/mri images and those seen by the otorhinolaryngologist are helpful to perform this task. Owing to the permeative nature of this process, it may mimic a tumor (9). Figure 11b. MRI is superior to CT for the diagnosis of discitis and osteomyelitis, particularly early in the course of disease, and should be performed if discitis or osteomyelitis is suspected. ■ Identify common pathologic entities found at neck CT in the emergency department. Figure 3. Tonsillitis in a 34-year-old man. Still, risk factors for development of thyroid abscesses include immunodeficiency and underlying gland abnormalities such as thyroid nodules, thyroid cancer, and fourth branchial cleft anomalies. There are two main cervical fasciae: the superficial cervical fascia (SCF) and deep cervical fascia (DCF). The paralysis manifests as dilatation of the ipsilateral piriform sinus and laryngeal ventricle, medial rotation and thickening of the ipsilateral aryepiglottic fold, and anteromedial displacement of the ipsilateral arytenoid cartilage. Therefore radiologists should be familiar with neck CT anatomy and lymph node levels to correctly interpret and report the exam. Thickening of the platysma muscle is commonly seen secondary to inflammation or infection of adjacent structures and serves as a beacon to draw attention to the adjacent area. The slides in the web-based format may be made larger by maximizing the window. However, extracapsular tumor extension can mimic inflammatory stranding where there are indistinct nodal margins or after biopsy and radiation when the lymph node may have poorly defined margins (45). Applied Radiological Anatomy and Anatomy for Diagnostic Imaging – Ryan. Images with a thickness of 2.5 mm are constructed in the axial, sagittal, and coronal planes by using a soft-tissue kernel and in the axial plane by using a bone kernel. Branchial cleft anomalies can manifest as a cyst where there is no internal or external connection, as a sinus where there is only an external connection, or as a fistula where there are openings on the skin and pharyngeal surfaces (11). Methods: Active learning was achieved by creating five radiology tutorial units that target content areas dealing with standard and cross-sectional radiographic anatomy and arterial angiography.

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