Mimics of Neck Lesions in Post Treatment Neck Surveillance

Abstract

This talk highlights the possible mimics seen in a busy oncology centre during a follow up imaging, especially ultrasound (US) of the neck. Various innocuous findings may be mistaken for recurrent or residual disease causing confusion due to inexperience or an apparent lack of knowledge. All the findings, which may lead to an erroneous diagnosis, have been divided into the following categories. Thyroid and salivary gland abnormalities, nodal, vascular, neurogenic, cartilaginous, bony and soft tissue abnormalities. These include several conditions which mimic metastatic nodes, extra capsular nodal spread, residual lesions of thyroid bed, parathyroid adenomas and a few specific lesions such as Kutteners tumor of submandibular gland. Post operative or foreign body granulomas may mimic soft tissue recurrences or laryngeal neoplasm. In two cases parasitic pathology was identified causing concern for neoplasm. Calcified, necrotic or non necrotic tuberculous lymph nodes also form an important subset due to its high incidence in some countries. Normal thymic and tonsillar tissue also adds to the confusion. These various normal and abnormal findings in Head and Neck cancer follow-up need to be understood by radiologists of various levels of expertise in busy imaging departments.