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Clinical Problem Solving: Radiology
September 2009

Radiology Quiz Case 2

Author Affiliations
 

C. DOUGLASPHILLIPSMD

Arch Otolaryngol Head Neck Surg. 2009;135(9):941. doi:10.1001/archoto.2009.134-a

A 39-year-old man presented with recurrent attacks of sore throat, dysphagia, persistent halitosis, ear pain, and a hard swelling in the left submandibular region. He stated that he had had an episode involving similar symptoms 7 years earlier and that the mass had ruptured, causing an exudation of pus. His medical history was remarkable for 30 years of tobacco use.

Examination of the oropharynx revealed a large, immobile, hard swelling arising from the left tonsil. There was no trismus or mucosal ulceration. A tonsillar mass with restricted mobility was bimanually palpable behind the left angle of the mandible. A plain lateral neck radiograph (1) showed irregular dense opacities at the left angle of the mandible, extending well below the lower border of the mandible. The mass had no soft-tissue component. Computed tomography of the neck revealed a large bone density mass, measuring approximately 45 × 25 × 20 mm (vertical and anteroposterior and medial to lateral diameter) in the left tonsillar region, extending 1 cm inferior to the angle of the mandible (2 and 3). There was no clinical or radiologic evidence of lymphadenopathy. Treatment consisted of surgical exploration and removal of the mass.

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