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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.
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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).

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Figure 1.
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Figure 2.
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Figure 3.
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Figure 4.
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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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