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Clinical Problem Solving: Radiology
November 2005

Radiology Quiz Case 1

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2005;131(11):1023. doi:10.1001/archotol.131.11.1023

A 75-year-old white woman presented with a 2-month history of a lump in the right side of her neck. She stated that the mass was getting bigger, but there was no associated skin discoloration or pain. She did not have a history of trauma, and, except for mild hypertension, her general health condition was good. She did not drink alcohol or smoke.

An otorhinolaryngologic examination revealed serous otitis media of the right ear; a right-sided lobulated, dark-brown/black mass in the nasopharynx; and a hard, semifixed, 2.5-cm lump at the posterosuperior border of level II in the right side of the neck. The nasopharyngeal mass was relatively isointense on T1-weighted magnetic resonance images (MRIs), but the neck node was hyperintense on non–contrast-enhanced T1-weighted MRIs (Figure 1 and Figure 2). Compared with normal mucosa, the nasopharyngeal lesion was relatively hypointense on T2-weighted MRIs (Figure 3). The node was heterogeneous on fat-saturated T2-weighted MRIs, with areas of low signal intensity interspersed with areas of high signal intensity (Figure 4).