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Clinical Problem Solving: Radiology
August 2007

Radiology Quiz Case 1

Author Affiliations

Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Otolaryngol Head Neck Surg. 2007;133(8):834. doi:10.1001/archotol.133.8.834

An otherwise healthy 59-year-old man presented with a 6-month history of a painless swelling in the right temporal region. He stated that the swelling had not changed in size since he had first noticed it. On palpation, the mass was indolent, immobile, and nontender. Clinical examination revealed no abnormality of the right parotid gland. Facial nerve function and sensitivity were intact. The patient did not recall a history of any trauma to the right temporal region.

Ultrasonography detected a tumor measuring 2 × 1 cm in diameter, with smooth margins. The tumor was independent of the parotid gland. The findings of fine-needle aspiration cytology were not specific. Computed tomography with contrast media (Figure 1) excluded bony erosion but showed central hypodensity and marginal hyperdensity. Magnetic resonance imaging revealed infiltration of the right temporal muscle. Both the T2-weighted image (Figure 2) and the fat-saturated, postgadolinium T1-weighted image (Figure 3) demonstrated a nonhomogeneous distribution of the contrast media, with concentrated enhancement in the periphery of the tumor. There were no abnormal lymph nodes in the head and neck area. Bilateral mucosal hyperplasia of the maxillar and ethmoidal sinus was a secondary finding.