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Clinical Problem Solving: Radiology
June 20, 2011

Radiology Quiz Case 2

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Arch Otolaryngol Head Neck Surg. 2011;137(6):629. doi:10.1001/archoto.2011.82-a

A 35-year-old man presented with a 1-year history of an indolent, slow-growing mass in the right parotid-masseteric region. The lesion, which measured approximately 2.5 cm in diameter, had a hard elastic consistency on palpation and was attached to the deep planes but did not affect the soft tissues of the cheek. The patient was asymptomatic except that he had occasional discomfort during chewing. His family history revealed no clinically significant diseases.

Clinical examination of the head and neck region was negative for synchronous lesions. There were no motor or sensory disturbances. Ultrasonography showed that the lesion was deeply located in the masseteric region, in contact with muscular fibers, with well-defined margins and a solid hyperechoic structure. The findings of ultrasonography-guided fine-needle aspiration biopsy were inconclusive owing to the absence of adequate cytologic material. Magnetic resonance imaging with gadolinium paramagnetic contrast was performed (Figures 1, 2, and 3).

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