Clinical Problem Solving: Radiology |

Radiology Quiz Case 2

Julie Chandra, MBBS, MA, MRCS; Olga Kirmi, BSc, MBBS, MRCS, FRCR; Eric K. Woo, MBBS, MRCP, FRCR
Arch Otolaryngol Head Neck Surg. 2010;136(9):925. doi:10.1001/archoto.2010.141-a.
Text Size: A A A
Published online


A 23-year-old man presented with a hard lump in the left side of his neck. He had noticed the swelling for a few years. The mass had gradually increased in size, but it was not painful. He was otherwise healthy and had no symptoms of dysphagia, odynophagia, or hoarseness. He did not smoke, and there was no relevant family history.

Physical examination revealed a deep 3 × 3-cm mass in the left side of the neck, with no cervical lymphadenopathy. He was afebrile and had a normal heart rate. No abnormalities were seen on flexible nasoendoscopy of the oropharynx and larynx. A complete blood cell count and an erythrocyte sedimentation rate were both normal. Magnetic resonance imaging of the neck showed a well-defined 2 × 3 × 3-cm paravertebral mass lying deep to the sternocleidomastoid muscle and displacing the common carotid artery and internal jugular vein anteriorly, with no invasion of adjacent structures. The lesion had a peripheral zone that was isointense to skeletal muscle on an axial T1-weighted sequence (Figure 1, arrowhead) and a high signal on a coronal short tau inversion recovery (STIR)-weighted sequence (Figure 2, arrowhead). A central area of very low signal was observed on both T1- and STIR-weighted sequences (Figure 1and Figure 2). Plain radiographs of the cervical spine (Figure 3) were obtained. A review of the patient's medical chart revealed that he had previously undergone radiography of his a left shoulder for an unrelated problem (Figure 4).

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Graphic Jump Location




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles

The Rational Clinical Examination
Evidence Summary and Review 2

The Rational Clinical Examination
Detecting Pleural Effusion by Chest Radiograph