R. NICKBRYANMDS. JAMESZINREICHMD
A 22-YEAR-OLD woman presented because of painless swelling that remained in the right side of her oropharynx after an episode of acute tonsillitis. She did not complain of dysphagia, odynophagia, or otalgia.
Examination of her oropharynx revealed a soft, nonpulsatile, nonpainful swelling behind the right posterior tonsillar pillar. There was no trismus. There were no symptoms or signs of acute infection.
A computed tomographic scan was obtained, and a cystic mass was evident medial to the great vessels of the neck (Figure 1). The mass affected the right parapharyngeal space, but there were no signs of infiltration or destruction of the structures of this space. A fine-needle aspiration biopsy was performed, and purulent fluid was evacuated. The culture yielded Streptococcus viridans and Prevotella melaninogenicus. Microscopic examination did not show any evidence of malignant disease. The patient was treated with cefazolin for 2 weeks, but the lesion reappeared soon after the treatment was discontinued. Because the patient rejected surgical treatment, she was observed periodically for 5 months, with no change in the appearance or volume of the mass. She finally agreed to surgical treatment but would not allow a cervical approach. The mucosa of the oropharynx was opened with the patient under general anesthesia, and a soft, encapsulated mass medial to the internal carotid artery was removed.
Alvarez JC, Morís C, Méndez JC, Fuente E. Imaging Quiz Case 2. Arch Otolaryngol Head Neck Surg. 1998;124(5):603-605. doi:10.1001/archotol.124.5.602