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Clinical Challenge
July 2018

A Man With a Midline Lesion Within the Oral Tongue

Author Affiliations
  • 1Department of Neuroradiology, Montefiore Medical Center, Bronx, New York
JAMA Otolaryngol Head Neck Surg. 2018;144(7):639-640. doi:10.1001/jamaoto.2018.0873

A man in his 30s with a medical history of asthma, social history of smoking, and allergy to shellfish presented to the emergency department with tongue swelling. The patient reported a history of a local burn from hot food but denied any history of trauma, foreign body, or piercing. He was evaluated, given a presumptive diagnosis of sialadenitis, and discharged home with ibuprofen and clindamycin. He returned several days later with worsening tongue swelling, voice change, and subjective fever. Postcontrast axial computed tomography (CT) demonstrated a midline lesion within the oral tongue that was predominantly hypodense and demonstrated rim enhancement. No calcifications were seen within the lesion (Figure, A). The lesion was predominantly isointense to muscle on axial T1-weighted images without intravenous (IV) contrast (Figure, B). Axial T2-weighted images with fat saturation showed predominantly hyperintense signal relative to muscle as well as punctate internal foci of T2 hypointensity (not shown). The lesion was hyperintense on diffusion-weighted imaging (Figure, C) and hypointense on the apparent diffusion coefficient map (not shown). Sagittal T1-weighted magnetic resonance imaging (MRI) with IV contrast and fat suppression demonstrated signal hypointense to muscle centrally with peripheral enhancement (Figure, D).

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