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Clinical Problem Solving: Radiology
December 2001

Radiology Quiz Case 1

Author Affiliations
 

R. NICKBRYANMDS. JAMESZINREICHMD

Arch Otolaryngol Head Neck Surg. 2001;127(12):1506. doi:10.1001/archotol.127.12.1506

A 24-YEAR-OLD WOMAN presented with a swelling at the back of her mouth. It had been present all her life but only recently had become sore and was causing dysphagia. Examination revealed a smooth, egg-sized swelling at the base of the tongue (Figure 1).

Flexible fiberoptic nasal endoscopy showed a significant narrowing of the airway at the level of the tongue base. Sagittal T1-weighted magnetic resonance images showed a 2.5 × 3.0-cm well-circumscribed mass at the base of the tongue (Figure 2). The lesion contained a homogeneous area of high-signal intensity superiorly, consistent with lipid. A low signal in the inferior portion of the mass was of similar intensity to cerebrospinal fluid on all sequences. Technetium Tc 99m pertechnetate scanning revealed uptake of the material in the region of the oropharynx and some washout in the area of the salivary glands but no uptake in the neck (Figure 3).

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