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Clinical Problem Solving: Radiology
May 2013

Radiology Quiz Case 2

JAMA Otolaryngol Head Neck Surg. 2013;139(5):523. doi:10.1001/jamaoto.2013.2878a

A 51-year-old man presented with a history of dysphagia and dysarthria. On physical examination, he was found to have a palpable mass in the left submandibular space, extending into the floor of the mouth. Tongue fasciculations and decreased movement of the tongue were also noted. A contrast-enhanced computed tomographic examination demonstrated a hypodense multilobulated mass in the left submandibular space with extension into the floor of the mouth and lateral displacement of the mylohyoid muscle (Figure 1 and Figure 2). Subsequent contrast-enhanced magnetic resonance imaging (MRI) scan demonstrated a T2 hyperintense and enhancing lesion centered in the left submandibular space with extension into the genioglossus and floor of the mouth (Figure 3 and Figure 4). A fine needle aspiration indicated a salivary gland neoplasm. The preoperative differential diagnosis centered on pleomorphic adenoma, while primary malignant lesion, metastatic disease to the submandibular gland and infection were considered less likely.