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Clinical Problem Solving: Radiology
January 18, 2010

Radiology Quiz Case 2

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Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Otolaryngol Head Neck Surg. 2010;136(1):96. doi:10.1001/archoto.2009.183-a

A 25-year-old man presented with a 1-year history of a mass in the right side of his neck that had shown evidence of recent growth. The patient denied any pain, dysphagia, or dysphonia. There was also no history of neck trauma. On physical examination of the neck, a firm 3 × 3-cm mass was palpable at the level of the thyroid cartilage, right of the midline. The mass, which was nontender and nonpulsatile, was not compressible and did not move with swallowing.

Computed tomography of the neck revealed a 3.6 × 2.5-cm, hypervascular, noncystic mass located anteromedially to the sternocleidomastoid muscle on the right side. No phleboliths or calcifications were noted. T2-weighted magnetic resonance imaging (MRI) with fat saturation showed a hyperintense, well-circumscribed mass embedded in the strap muscles (Figure 1). The mass was located superior to the thyroid gland. No large feeding vessels were detected. T1-weighted MRI with gadolinium showed avid enhancement of the mass with punctate foci of central hypointensity (Figure 2). The preoperative differential diagnosis included a vascular lesion within the strap muscles and a thyroglossal duct cyst.

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