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Radiology Quiz Case 2

Radiology Quiz Case 2 A 22-day-old male neonate who was born full term to a primiparous mother presented with a rapidly enlarging swelling in the left side of his neck. He had been evaluated by his pediatrician at day of life 17 and was found to have a soft left-sided neck mass. An ultrasonogram obtained on day of life 20 demonstrated a cystic-appearing mass in the left side of the neck. Physical examination revealed a well-developed, well-nourished neonate who was not in any acute distress and was otherwise in good health. He had no stridor and was feeding comfortably. The mass, which was 5 to 6 cm in diameter, was soft, without tenderness to palpation. There was no evidence of overlying erythema or edema. The results of the rest of the examination, including an intraoral examination and fiberoptic laryngoscopy, were normal. Magnetic resonance imaging with and without contrast (Figure 1 and Figure 2) showed a mildly enhancing, homogeneous, T1 and T2 hyperintense left-sided mass, measuring 2.8 × 2.4 × 2.7-cm, centered in the region of the submandibular space. The mass displaced the submandibular gland anteriorly, the parotid gland superiorly and laterally, and the carotid sheath posteriorly. It appeared to insinuate itself around the posterior digastric muscle. There was mild deviation of the patient's airway to the right. Because the mass did not appear cystic on the magnetic resonance images, subsequent ultrasonography with Doppler imaging was performed, and the findings showed that the mass had an echotexture that was similar to that of muscle, with internal vascularity but no cystic elements. On day of life 22, the patient was taken to the operating room for direct laryngoscopy, bronchoscopy, and transcervical excision of the mass (Figure 3), which was seen immediately deep to the platysma. The hypoglossal nerve was passing through the mass. Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. View LargeDownload What is your diagnosis? http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Radiology Quiz Case 2

Abstract

A 22-day-old male neonate who was born full term to a primiparous mother presented with a rapidly enlarging swelling in the left side of his neck. He had been evaluated by his pediatrician at day of life 17 and was found to have a soft left-sided neck mass. An ultrasonogram obtained on day of life 20 demonstrated a cystic-appearing mass in the left side of the neck. Physical examination revealed a well-developed, well-nourished neonate who was not in any acute distress and was otherwise in...
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Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archoto.2011.5-a
Publisher site
See Article on Publisher Site

Abstract

A 22-day-old male neonate who was born full term to a primiparous mother presented with a rapidly enlarging swelling in the left side of his neck. He had been evaluated by his pediatrician at day of life 17 and was found to have a soft left-sided neck mass. An ultrasonogram obtained on day of life 20 demonstrated a cystic-appearing mass in the left side of the neck. Physical examination revealed a well-developed, well-nourished neonate who was not in any acute distress and was otherwise in good health. He had no stridor and was feeding comfortably. The mass, which was 5 to 6 cm in diameter, was soft, without tenderness to palpation. There was no evidence of overlying erythema or edema. The results of the rest of the examination, including an intraoral examination and fiberoptic laryngoscopy, were normal. Magnetic resonance imaging with and without contrast (Figure 1 and Figure 2) showed a mildly enhancing, homogeneous, T1 and T2 hyperintense left-sided mass, measuring 2.8 × 2.4 × 2.7-cm, centered in the region of the submandibular space. The mass displaced the submandibular gland anteriorly, the parotid gland superiorly and laterally, and the carotid sheath posteriorly. It appeared to insinuate itself around the posterior digastric muscle. There was mild deviation of the patient's airway to the right. Because the mass did not appear cystic on the magnetic resonance images, subsequent ultrasonography with Doppler imaging was performed, and the findings showed that the mass had an echotexture that was similar to that of muscle, with internal vascularity but no cystic elements. On day of life 22, the patient was taken to the operating room for direct laryngoscopy, bronchoscopy, and transcervical excision of the mass (Figure 3), which was seen immediately deep to the platysma. The hypoglossal nerve was passing through the mass. Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. View LargeDownload What is your diagnosis?

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Feb 21, 2011

Keywords: diagnostic radiologic examination,radiology specialty

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