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Clinical Problem Solving: Radiology |

Radiology Quiz Case 1

Victor Helmstaedter, MD; Carsten Maximilian Pietsch, MD; Karl-Bernd Huttenbrink, MD; Dirk Beutner, MD
Arch Otolaryngol Head Neck Surg. 2007;133(8):834. doi:10.1001/archotol.133.8.834.
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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.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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