ì  CALCIFIED  ATHEROSCLEROTIC  PLAQUE  

Defini&on:    Steno'c  atheromatous  plaque  in  the  extracaro'd  vasculature.    

Radiographic  findings:  ì  Loca'on:    •  At  the  greater  cornu  of  the  hyoid  bone  •  Adjacent  to  the  cervical  vertebra  C3,  C4,  or  the  intervertebral  space                    between  them.    ì  Periphery  and  shape:    •  Mul'ple,  irregular  in  shape  •  Sharply  defined  border  •  Ver'cal  linear  distribu'on  ì  Internal  Structure:      •  Heterogeneous  radiopacity  with  radiolucent  voids  

ì  Differen&al  Diagnosis:    

•  Calcified  tri'ceous  car'lage  

 ì  Management:    •  Risk  factor  for  cerebrovascular  accident  and  stroke  •  Referral  to  a  physician  

SIALOLITH    ì  Defini&on:    •  Stones  within  ducts  of  salivary  glands    ì  Clinical  features:    •  Men  (middle  and  later  years)  •  Usually  singly  (70%  to  80%),  mul'ple  in  the  paro'd  gland  

•  Asymptoma'c  (discomfort  intensify  at  meal'mes)  •  9%  with  recurrent  sialolithiasis  •  10%  with  nephrolithiasis  

Radiographic  Features:  

ì  Loca'on:    

•  83%  to  94%  in  the  submandibular  gland    Ø  50%  in  distal  por'on  of  Wharton’s  duct  Ø  20%  in  the  proximal  por'on  Ø  30%  in  the  gland  

•  4%  to  10%  in  the  paro'd  gland  

•  1%  to  7%  in  the  sublingual  gland  

ì  Periphery  and  Shape:    

•  In  duct-­‐  cylindric,  very  smooth  border  

•  In  hilus  of  gland-­‐  larger,  more  irregularly  shaped  

ì  Internal  Structure:  

•  Homogenous  radiopacity  

ì  Applied  Radiology:  

•  Periapical  view  at  lower  premolar  and  molar  apices  

•  Distal  por'on  of  Wharton’s  duct:  Mandibular  occlusal  view  

•  More  posterior  loca'on:  Lateral  oblique  view  or  panoramic  image  

•  Paro'd  duct  gland:    Ø  Periapical  film  in  the  buccal  ves'bule  Ø  Anteroposterior  skull  view  (“blows  out”  the  cheek)  

•  Noncalcified  stone:  Sialography      

ì  Differen&al  Diagnosis:  

•  Calcifica'on  of  the  lymph  nodes  

•  Phleboliths  

ì  Management:  

•  Small  stone:  “Milked  out”  by  bimanual  palpa'on  

•  Large  stone/in  proximal  duct:  Nonsurgical  or  minimally  invasive  sialolithomy  

PHLEBOLITHS  

ì  Defini&on:  

•  Calcified  thrombi  in  veins/  venulae,  or  sinusoidal  vessels  of  hemangiomas.  

ì  Clinical  features:  

•  Hemangioma  

•  Swollen  so_  'ssue  with  throbbing  and  blanching  

•  Fluctuate  in  size  

•  Ausculta'on  reveal  a  bruit  (in  cavernous  type)  

Radiographic  Features:  

ì  Loca'on:  In  hemangiomas  ì  Periphery  and  Shape:    •  Round  or  oval  (from  the  side  resemble  a  straight  or  slightly  curved  

sausage)  

•  Mul'ple,  random  and  clustered  distribu'on  •  6mm  diameter  •  Smooth  periphery  ì  Internal  structure:    

•  Homogenous  radiopacity  and  lamina'ons  (give  a  bull’s  eye  or  “target”  appearance)  

•  Radiolucent  center    

ì  Differen&al  Diagnosis:    

•  Sialolith  

•  Calcified  lymph  nodes  

LARYNGEAL  CARTILAGE  CALCIFICATIONS  

ì  Defini&on:    

•  Calcifica'on  or  ossifica'on  of  hyaline  car'lage  in  the  thyroid  and  tri'ceous  car'lages.  

ì  Clinical  features:  

•  Incidental  radiographic  finding  with  no  clinical  features  

Radiographic  Features:  ì  Loca'on:    •  Inferior  to  the  greater  cornu  of  the  hyoid  bone  •  Adjacent  to  the  superior  border  of  C4  

ì  Periphery  and  Shape:  •  7  to  9  mm  in  length,  2  to  4  mm  in  width  •  Smooth  and  well  defined  periphery  ì  Internal  Structure:  •  Homogenous  radiopacity  (occasionally  with  outer  cortex)  

ì  Differen&al  Diagnosis:  

•  Calcified  atheromatous  plaque  

ì  Management:  

•  No  treatment  

RHINOLITH/ANTROLITH  ì  Defini&on:  

•  Calcerous  concre'ons  in  nose  (rhinoliths)  or  antrum  of  maxillary  sinus  (antroliths)  

ì  Clinical  Features:  

•  Asymptoma'c  for  a  long  period  of  'me  

•  Pain,  ulcera'on,  and  conges'on  (the  expanding  mass  impinge  on  mucosa)  

•  Unilateral  rhinnorhea    

•  Sinusi's  

•  Headache  

•  Epistaxis    

•  Anosmia    

•  Fetor  

•  Fever  

Radiographic  Features:  ì  Loca'on:    •  Rhinolith  in  the  nose  •  Antrolith  in  the  antrum  of  maxillary  sinus  ì  Periphery  and  Shape:  •  A  variety  of  shapes  and  sizes  ì  Internal  Structure:  •  Homogenous  or  heterogenous  radiopacity  •  Some'mes  with  lamina'ons  •  Density  may  exceed  the  surrounding  bone  

ì  Differen&al  Diagnosis:  •  Osteoma  •  Odontoma  •  Surgical  ciliated  cyst  •  Mycolith  ì  Management:  •  Referred  to  otorhinolaryngologist  (for  endonasal  surgical  

removal)  •  Lithotripsy  if  large