EURORAD ESR

Case 14664

Neck mass - the power of radiology to avoid biopsy when it is not necessary!

Author(s)
Romeu Mesquita, Marta Sousa, Alcinda Reis

Hospital de São Sebastião,
Centro Hospitalar de Entre o Douro e Vouga,
Radiologia;
4250-268 Porto, Portugal;
Email:romeu.mesquita@gmail.com
 
Patient
female, 38 year(s)
 
 
  • Figure 1
    Ultrasound

    US shows a hypoechoic lesion with hyperechoic linear striations, without apparent vascular flow on colour Doppler.

     
    Area of Interest: Head and neck; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 2
    Axial CT images.

    Axial non-contrast CT images show subtle hyperdense foci (arrow in a) within a left level II soft tissue mass and nonspecific surrounding fatty 'inflammatory' change (arrow in b).

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 3
    Axial CT images with contrast.

    Multiphase axial CT images with contrast show a trans-spatial lesion that enhances slowly and demonstrates some venous wash-out.

     
    Area of Interest: Head and neck; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 4
    CT neck with contrast-MPR.

    Coronal (a) and sagittal (b) CT images demonstrate the venous malformation.

     
    Area of Interest: Head and neck; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 5
    CT neck with contrast- Curved MPR.

    Curved multiplanar reformatted images better depicte the extension of the lesion.

     
    Area of Interest: Head and neck; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 6
    MR STIR images.

    Axial (a) and coronal (b) STIR images show a hyperintense vascular malformation.

     
    Area of Interest: Head and neck; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 7
    Axial MR T1W and T2W images.

    T1 (a) and T2 (b) axial MR images show an isointense to muscle (T1) and hyperintense (T2) lesion abutting the oropharyngeal wall.

     
    Area of Interest: Head and neck; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
  • Figure 8
    Axial T1W MR image with contrast.

    MR image with gadolinium shows strong internal enhancement.

     
    Area of Interest: Head and neck; Imaging Technique: MR-Angiography; Procedure: Diagnostic procedure; Special Focus: Haemodynamics / Flow dynamics;
     
     
US shows a hypoechoic lesion with hyperechoic linear striations, without apparent vascular flow on colour Doppler.
 
Axial non-contrast CT images show subtle hyperdense foci (arrow in a) within a left level II soft tissue mass and nonspecific surrounding fatty 'inflammatory' change (arrow in b).
 
Multiphase axial CT images with contrast show a trans-spatial lesion that enhances slowly and demonstrates some venous wash-out.
 
Coronal (a) and sagittal (b) CT images demonstrate the venous malformation.
 
Curved multiplanar reformatted images better depicte the extension of the lesion.
 
Axial (a) and coronal (b) STIR images show a hyperintense vascular malformation.
 
T1 (a) and T2 (b) axial MR images show an isointense to muscle (T1) and hyperintense (T2) lesion abutting the oropharyngeal wall.
 
MR image with gadolinium shows strong internal enhancement.
 
 
 
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