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Clinical Problem Solving: Radiology
March 2005

Radiology Quiz Case 2

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2005;131(3):275. doi:10.1001/archotol.131.3.275

A healthy 9-month-old African American girl was found to have a mass in the right side of her neck that had been present since birth. There was no history of trauma. On examination, a raised mass that was smaller than 5 mm in greatest dimension was observed in the skin on the right side of the neck, anterior and superficial to the sternocleidomastoid muscle. The mass was thought to be the opening to a fistula tract, but there was no history of drainage from this site. No other neck masses were palpated. The findings of the rest of the head and neck examination were within normal limits. The patient underwent a computed tomographic scan that revealed a poorly defined mass in the right side of the neck, extending inferiorly from the level of the parotid gland at the angle of the mandible approximately through the level of the hyoid. The mass was isodense to muscles on enhanced computed tomographic scans (Figure 1). Magnetic resonance imaging, which was recommended for further characterization of the mass, showed a well-defined, 22×20×15-mm mass abutting the deep lobe of the parotid gland and causing marked lateral displacement of the right parotid gland (Figure 2). The mass was isointense to muscle on T1-weighted images (Figure 3) and slightly brighter than muscle on T2-weighted images (Figure 4). It was isointense to normal lymph nodes (jugulodigastric nodes). Further workup included fine-needle aspiration, the results of which were nondiagnostic because the sample was bloody. A complete blood cell count was normal. The patient was taken to the operating room for surgical excision of the mass.

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