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Clinical Problem Solving: Radiology
October 2005

Radiology Quiz Case 4

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Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Otolaryngol Head Neck Surg. 2005;131(10):924. doi:10.1001/archotol.131.10.924

A 38-year-old woman presented with a 1-month history of gradual swelling over the left side of her neck. The swelling was not associated with any other upper aerodigestive tract symptoms. Her medical and social histories were insignificant. Her twin sister had been diagnosed as having breast cancer about 1 year earlier.

Clinical examination revealed a 1.5 × 2.0-cm, firm to hard swelling over the left side of the neck. Palpation of the mass produced paresthesia that radiated into the left upper extremity. When fine-needle aspiration of the mass was performed, the patient felt the same paresthesia in her neck and arm. The fine-needle aspirate showed clusters of spindle cells. A postcontrast axial computed tomographic scan of the neck showed (Figure 1) a lesion in the left side of the lower neck area. A T1-weighted coronal magnetic resonance image (MRI) demonstrated a low signal intensity lesion in the left side of the neck (Figure 2), and a T2-weighted coronal (Figure 3) MRI demonstrated a high signal intensity lesion.

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