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Residents Page: Imaging
May 1999

Imaging Quiz Case 1

Author Affiliations
 

R. NICKBRYANMDS. JAMESZINREICHMD

Arch Otolaryngol Head Neck Surg. 1999;125(5):592. doi:

Dysphagia is an uncommon initial presentation for a vallecular cyst. Children often present with inspiratory stridor,15 which is particularly dangerous for infants and may be exacerbated by agitation, feeding, and supine positioning.3 In the past, vallecular cysts were frequently overlooked, and as many as to 50% were discovered at autopsy.1 Large cysts may obstruct the airway and also cause dysphagia.2 Also, mass lesions in the base of the tongue have the potential to excite the gag reflex and induce gagging and vomiting.6 Unusual reported presentations of vallecular cysts have included acute airway obstruction and apnea in a child undergoing sedation and failure to thrive in an infant.4,7,8 In our case, magnetic resonance imaging revealed a circular vallecular mass. The axial T1-weighted image (Figure 1) demonstrated a midline mass with low to intermediate signal intensity. This finding of a homogeneous, circumscribed mass at the base of the tongue is consistent with a retained mucous or mass lesion. On the sagittal T2-weighted image (Figure 2), the mass has high signal intensity consistent with a high protein content fluid. There were no flow voids on either image or extensions of the mass into the surrounding soft tissue. The thyroid scan (Figure 3) demonstrated no functioning thyroid tissue at the base of the tongue.

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