CALCIFIED ATHEROSCLEROTIC PLAQUE

Definition: Stenotic atheromatous plaque in the extracarotid vasculature.

Radiographic findings: Location: • At the greater cornu of the hyoid bone• Adjacent to the cervical vertebra C3, C4, or the intervertebral space

between them. Periphery and shape: • Multiple, irregular in shape• Sharply defined border• Vertical linear distribution Internal Structure: • Heterogeneous radiopacity with radiolucent voids

Differential Diagnosis:

• Calcified triticeous cartilage

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

SIALOLITH Definition: • Stones within ducts of salivary glands

Clinical features: • Men (middle and later years)• Usually singly (70% to 80%), multiple in the parotid gland• Asymptomatic (discomfort intensify at mealtimes)• 9% with recurrent sialolithiasis• 10% with nephrolithiasis

Radiographic Features:

Location:

• 83% to 94% in the submandibular gland 50% in distal portion of Wharton’s duct 20% in the proximal portion 30% in the gland

• 4% to 10% in the parotid gland

• 1% to 7% in the sublingual gland

Periphery and Shape:

• In duct- cylindric, very smooth border

• In hilus of gland- larger, more irregularly shaped

Internal Structure:

• Homogenous radiopacity

Applied Radiology:

• Periapical view at lower premolar and molar apices

• Distal portion of Wharton’s duct: Mandibular occlusal view

• More posterior location: Lateral oblique view or panoramic image

• Parotid duct gland: Periapical film in the buccal vestibule Anteroposterior skull view (“blows out” the cheek)

• Noncalcified stone: Sialography

Differential Diagnosis:

• Calcification of the lymph nodes

• Phleboliths

Management:

• Small stone: “Milked out” by bimanual palpation

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

PHLEBOLITHS

Definition:

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

Clinical features:

• Hemangioma

• Swollen soft tissue with throbbing and blanching

• Fluctuate in size

• Auscultation reveal a bruit (in cavernous type)

Radiographic Features:

Location: In hemangiomas Periphery and Shape:

• Round or oval (from the side resemble a straight or slightly curved sausage)

• Multiple, random and clustered distribution• 6mm diameter• Smooth periphery Internal structure:

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

• Radiolucent center

Differential Diagnosis: Sialolith

LARYNGEAL CARTILAGE CALCIFICATIONS

Definition:

• Calcification or ossification of hyaline cartilage in the thyroid and triticeous cartilages.

Clinical features:

• Incidental radiographic finding with no clinical features

Radiographic Features: Location: • Inferior to the greater cornu of the hyoid bone• Adjacent to the superior border of C4

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

Differential Diagnosis:

• Calcified atheromatous plaque

Management:

• No treatment

RHINOLITH/ANTROLITH Definition:

• Calcerous concretions in nose (rhinoliths) or antrum of maxillary sinus (antroliths) Clinical Features:

• Asymptomatic for a long period of time

• Pain, ulceration, and congestion (the expanding mass impinge on mucosa)

• Unilateral rhinnorhea

• Sinusitis

• Headache

• Epistaxis

• Anosmia

• Fetor

• Fever

Radiographic Features: Location: • Rhinolith in the nose• Antrolith in the antrum of maxillary sinus Periphery and Shape:• A variety of shapes and sizes Internal Structure:• Homogenous or heterogenous radiopacity• Sometimes with laminations• Density may exceed the surrounding bone

Differential Diagnosis:• Osteoma• Odontoma• Surgical ciliated cyst• Mycolith Management:• Referred to otorhinolaryngologist (for endonasal surgical

removal)• Lithotripsy if large