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Differential diagnosis that all good radiologists should know OR: What residents should absolutely know prior to taking the Boards

NEURORADIOLOGY

***HEAD I. Cerebral Lesions A. Solitary Mass (a) tumor 1. glioma group

a. b. c. d.

low grade (type I) cellular astrocytoma (type II) anaplastic astrocytoma (type III) glioblastoma multiform or GBM (type IV)

2. 3. 4. 5. (b)

oligodendroglioma lymphoma solitary metastasis rare lesions - PNET, ependymoma, hamartoma, ganglioma

inflammatory 1. abscess/infection 2. MS vascular related 1. hemorrhage 2. infarct 3. AVM 4. cavernous hemangioma

(c)

B. Multiple Ring Enhancing Masses 1. metastasis 2. lymphoma 3. GBM 4. infection/abscess

- cystocercosis - toxoplasmis (AIDS)

5. rare-MS II. Pineal Lesions 1. cysts 2. germ cell tumors

- germinoma - teratoma

3. pineal cell tumors

a. pinealblastoma b. pinealcytoma

4. meningioma 5. astrocytoma III. Posterior Fossa Lesions A. Pediatric Cerebellar/4th vent masses 1. Astrocytoma 2. Medulloblastoma 3. ependymoma B. Adult 1. metastasis 2. astrocytoma 3. hemangioblastoma

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4. Medulloblastoma (RARE) C. Brainstem Lesions 1. glioma 2. vascular malformations 3. demyelination D. CPA (Cerebellar pontine angle) masses 1. Acoustic neuroma (80%) 2. Meningioma (10%) 3. Epidermoid 4. Other
- glomus jugular - arachnoid cyst - vascular

IV. Para-Sellar Lesions 1. pituitary adenoma 2. meningioma 3. aneurysm 4. craniopharyngioma 5. optic chiasmatic/hypothalamic glioma 6. clival lesions (see below) 7. rare
- arachnoid cyst - germinoma - sarcoidosis - histiocytosis X - tuberculosis - trigeminal neuroma - epidermoid/dermoid - metastatic disease

S A T C H M O

Mneumonic for sella lesion sarcoidosis adenoma, aneurysm, arachnoid cyst TB, teratoma, trigeminal neuroma craniopharyngioma, clival lesions hypothalmic glioma, histocytosis meningioma, mets optic glioma

V.

Clival Lesions 1. Meningioma 2. Chordoma 3. Chondrosarcoma 4. parasellar lesion 5. metastasis

VI. Skull Base A. Parasellar B. Clival C. Jugular foramen

- glomus jugular - schwannoma - meningioma - vascular

D. Mets E. Nasopharyngeal mass invasion

VII. Extra-axial & Extra-parenchymal A. Meningeal 1. meningioma 2. carcinomatosis meningitis 3. lymphoma/leukemia 4. infection 5. dural metastasis-breast, prostate, neuroblastoma

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B. Ventricular 1. colloid cyst 2. rare choroid plexus papilloma, meningioma,

ependymoma glioma, neuroepithelial cyst

***ORBIT VIII. Orbit A. Intraconal 1. hemangioma 2. optic nerve glioma 3. meningioma (pseudotumor/lymphoma) B. Extraconal/EOM 1. pseudotumor/lymphoma 2. lymphangioma 3. Grave's Disease 4. mets 5. rhabdomyosarcoma 6. subperiosteal abscess/hematoma ***SPINE IX. Spine A. Extradural (Epidural) 1. spondylosis 2. disc disease 3. epidural mets (prostate, breast, lung) 4. lymphoma 5. osteomyelitis B. Intradural extramedullary 1. schwannoma/neurofibroma 2. meningioma 3. drop mets GBM, PNET, pinealblastoma, ependymoma, 4. AVM and dural AVF C. Intradural intramedullary A. tumors 1. astrocytoma 2. ependymoma 3. hemangioblastoma 4. mets (rare - e.g. melanoma) B. inflammatory/other 1. MS 2. infection 3. traumatic/confusion 4. infarct 5. vascular malformations

medulloblastoma, germ cell tumors (germinoma)

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***ENT X. ENT A. Approach to Parapharyngeal space masses

POSTERIOR

(a). carotid space

1. glomus tumor 2. neuroma 3. vascular 1. infection 2. tumor

(b). retrophayngeal & prevertebral

LATERAL

(c). parotid space

1. parotid tumor - Pleomorphic adenoma (50-60%) 2. Cysts (AIDS) 3. abscess 4. parotitis/infections 1. infection 2. tumor

(d). masticator space

MEDIAL

(e). pharyngeal mucosal space

nasopharynx squamous cell CA minor salivary gland tumor

CENTRAL

(f). within parapharyngeal space

B. Middle ear masses 1. cholesteatoma 2. glomus tympanicum 3. aberrant carotid 4. Jugular bulb with dehiscience C. Nasal cavity / Nasopharynx / Sinuses 1. squamous cell CA (80-90%) 2. polyps/retention cysts 3. inflammatory sinus disease 4. rare lymphoma, melanoma, esthesioneuroblastoma,
rhabdosarcoma, plasmacytoma

D. Cystic Masses of Head and Neck 1. Necrotic lymph node or tumor - Carotid space 2. Abscess
a. b. c. d. parotitis dental tonsillitis osteomyelitis

- parotid space - mastoid space - retropharyngeal space - prevertebral space

3. 4. 5. 6.

Branchial cleft cyst - angle of jaw, anterior triangle Thyroglossal duct cyst - tongue base to hyoid Cystic hygroma - paravertebral & other spaces Diving ranula (obstructed salivary duct; pseudocyst)
- sublingual/submandibular space

7. Parotid cysts in AIDS