Head and neck differential diagnosis
Head and neck diagnoses are often decided by anatomical compartment and enhancement pattern rather than by signal alone. Each row pairs an alternative with the anatomical or enhancement feature that separated it in the source case.
| Alternative diagnosis | Feature that argues against it | Case |
|---|---|---|
| Bannayan-Zonana syndrome | Bannayan-Zonana syndrome causes multiple discrete lipomas together with macrocephaly, developmental delay and pigmented macules of the penis, rather than diffuse unencapsulated cervical fat. | Madelung disease type I |
| Calcified nasal polyp | A calcified polyp arises from the nasal mucosa, shows soft-tissue density with scattered calcification and is not surrounded by a bony follicle. | Ectopic nasal tooth |
| Calcifying epithelial odontogenic tumour | A calcifying epithelial odontogenic tumour contains scattered calcifications and amyloid-like material and is often associated with an impacted tooth. | Recurrent ameloblastoma of the right jaw after conservative surgery |
| Central giant cell granuloma | Central giant cell granuloma typically affects the anterior mandible of young patients, is multilocular with wispy septa and does not show the solid enhancing components of an ameloblastoma. | Recurrent ameloblastoma of the right jaw after conservative surgery |
| Coats disease | Coats disease causes exudative retinal detachment with hyperintense subretinal fluid and no retrolental mass or persistent hyaloid band, and it usually affects older boys. | Persistent hyperplastic primary vitreous |
| Congenital cystic eye | Congenital cystic eye is a pure cyst with no solid component, fat or calcification and represents complete failure of globe formation, whereas a teratoma contains tissues from multiple germ layers. | Congenital orbital teratoma |
| Congenital cystic eye | Congenital cystic eye is a complete failure of globe formation with a cystic orbital mass and no identifiable eye, whereas in PHPV a microphthalmic globe is present. | Persistent hyperplastic primary vitreous |
| Cowden syndrome | Cowden syndrome is characterised by hamartomas of the skin, breast, thyroid and brain with an increased risk of malignancy, and does not produce a symmetric mediastinal and cervical fatty mass. | Madelung disease type I |
| Drug-induced lipomatosis | Steroid or antiretroviral therapy produces a buffalo hump and centripetal fat accumulation with a characteristic drug history, and the fat distribution is usually less extensive and symmetric than in Madelung disease. | Madelung disease type I |
| Fibromatosis | Desmoid-type fibromatosis is a soft-tissue proliferation that infiltrates muscle and fascia without a well-defined osseous shell, whereas desmoplastic fibroma is centred within bone and expands the cortex. | Desmoplastic fibroma of the mandible |
| Foreign body | A foreign body has a characteristic density and shape of the ingested material, a clear history of insertion and no tooth-like crown or root architecture. | Ectopic nasal tooth |
| Glossopharyngeal neuralgia | Glossopharyngeal neuralgia produces severe throat pain triggered by swallowing but is not associated with an elongated styloid process or compression of adjacent structures. | Eagle syndrome |
| Haemangioma | A haemangioma enhances but lacks the characteristic location at the sphenopalatine foramen, the bony remodelling pattern and the arterial supply from the internal maxillary artery. | Juvenile nasopharyngeal angiofibroma |
| Juvenile nasal polyp | A juvenile polyp is a non-enhancing, fluid-signal mass within the nasal cavity without widening of the pterygopalatine fossa or intense vascularity. | Juvenile nasopharyngeal angiofibroma |
| Juvenile nasopharyngeal angiofibroma | Juvenile nasopharyngeal angiofibroma widens the pterygopalatine fossa and erodes the pterygoid plates in an adolescent boy with epistaxis, and it enhances avidly with flow voids. | Pterygopalatine fossa: a roadmap for disease spread |
| Le Fort I fracture | A Le Fort I fracture is a horizontal fracture through the maxilla above the tooth apices with pterygoid plate involvement, leaving the orbit and zygomas intact. | Le Fort III fracture (craniofacial disjunction) |
| Le Fort II fracture | A Le Fort II fracture is pyramidal and passes through the nasofrontal suture, medial orbital walls and infraorbital rims but spares the zygomaticofrontal sutures and zygomatic arches, so the zygomas remain attached to the cranium. | Le Fort III fracture (craniofacial disjunction) |
| Lymphoma of bone | Primary bone lymphoma causes permeative destruction with a large soft-tissue component, homogeneous enhancement and restricted diffusion, without the fibrous, low-T2 matrix of desmoplastic fibroma. | Desmoplastic fibroma of the mandible |
| Meningioma of the sphenoid wing | A meningioma extends into the fossa from the middle cranial fossa with dural thickening, hyperostosis and homogeneous enhancement, unlike the normal fat-containing space. | Pterygopalatine fossa: a roadmap for disease spread |
| Microphthalmos with cyst | Microphthalmos with cyst consists of a small globe continuous with a retrobulbar cyst, without solid enhancing tissue or calcification. | Congenital orbital teratoma |
| Nasopharyngeal carcinoma | Nasopharyngeal carcinoma occurs in older adults, causes infiltrative bone destruction and cervical nodal metastases, and is not a highly vascular mass with a blush on angiography. | Juvenile nasopharyngeal angiofibroma |
| Nerve sheath tumour | A schwannoma or neurofibroma produces a well-defined enhancing mass along the course of V2 with smooth enlargement of the foramen rotundum, rather than normal fat and symmetry. | Pterygopalatine fossa: a roadmap for disease spread |
| Neuroblastoma metastasis | Neuroblastoma metastasis produces permeative bone destruction with periosteal reaction and often calcification, and is associated with an elevated urinary catecholamine level in a younger child. | Desmoplastic fibroma of the mandible |
| Obesity | Obesity produces generalised fat deposition that follows the normal body contour and is not confined to the neck, shoulder girdle and mediastinum in a symmetric, mass-like fashion. | Madelung disease type I |
| Ocular toxocariasis | Toxocariasis produces a focal retinal granuloma with surrounding vitreous stranding and a history of contact with dogs or cats, without the congenital hyaloid stalk. | Persistent hyperplastic primary vitreous |
| Odontogenic keratocyst | An odontogenic keratocyst is usually unilocular, grows along the bone without marked expansion, does not resorb tooth roots and shows restricted diffusion from its keratin content. | Recurrent ameloblastoma of the right jaw after conservative surgery |
| Odontogenic myxoma | Odontogenic myxoma produces a fine, soap-bubble trabecular pattern and high T2 signal from myxoid stroma, without the solid enhancing nodules seen here. | Recurrent ameloblastoma of the right jaw after conservative surgery |
| Odontoma | An odontoma is a hamartomatous mass of dental tissues within the jaws, often with multiple denticles, and it does not lie free in the nasal floor. | Ectopic nasal tooth |
| Orbital encephalocoele | An encephalocoele herniates through a bony defect and contains brain tissue with cerebrospinal fluid, and it is continuous with the intracranial compartment rather than a multilineage tumour. | Congenital orbital teratoma |
| Ossifying fibroma | Ossifying fibroma has a well-defined bony shell with internal ossification that progresses from ground-glass to dense, unlike the purely lytic recurrent lesion described. | Recurrent ameloblastoma of the right jaw after conservative surgery |
| Otitis media | Otitis media causes ear pain, discharge and hearing loss with inflammatory changes in the middle ear on imaging, without styloid elongation. | Eagle syndrome |
| Perineural tumour spread | Perineural spread along the maxillary nerve obliterates the normal fat of the pterygopalatine fossa, enlarges the foramen rotundum and shows abnormal enhancement along V2, in contrast with the symmetric fat-filled fossa of normal anatomy. | Pterygopalatine fossa: a roadmap for disease spread |
| Retinoblastoma | Retinoblastoma arises within a formed globe, shows intraocular calcification and does not produce a large extraocular mass with fat and cystic components. | Congenital orbital teratoma |
| Retinoblastoma | Retinoblastoma typically arises in a normal-sized globe, contains calcification in most cases and forms an irregular intraocular mass without a persistent hyaloid stalk. | Persistent hyperplastic primary vitreous |
| Rhabdomyosarcoma | Rhabdomyosarcoma in a teenager is aggressive, destroys bone, shows marked enhancement and restricted diffusion and grows rapidly, in contrast with the slow, expansile growth of a desmoplastic fibroma. | Desmoplastic fibroma of the mandible |
| Rhabdomyosarcoma | Rhabdomyosarcoma destroys bone in a permeative fashion, grows rapidly and does not produce the smooth widening and bowing of the pterygopalatine fossa seen with an angiofibroma. | Juvenile nasopharyngeal angiofibroma |
| Rhinolith | A rhinolith is a laminated, irregular calcified mass formed around a nidus, lacks enamel and a pulp cavity, and is usually centred in the nasal airway rather than attached to the alveolar bone. | Ectopic nasal tooth |
| Temporomandibular joint disorder | Temporomandibular joint disorder causes pain and clicking localised to the joint with restricted opening, and the styloid process is of normal length. | Eagle syndrome |
| Trigeminal neuralgia | Trigeminal neuralgia produces paroxysmal electric-shock pain in a trigeminal distribution without a mechanical trigger on neck rotation or swallowing, and imaging shows a normal styloid process. | Eagle syndrome |
| Zygomaticomaxillary complex fracture | A zygomaticomaxillary complex fracture involves the zygomatic arch, lateral orbital wall and orbital floor on one side and produces malar depression without a mobile whole midface. | Le Fort III fracture (craniofacial disjunction) |
The confirmed diagnosis of each case is stated on the case page and is not repeated here. Sorted alphabetically; the order says nothing about probability.