Wk 2, Case 2 - Review

Patient History
36-year-old male presents with fever.

Findings
Contrast-enhanced CT was performed from the skull base to the thoracic inlet. There is an approximately 3cm x 2cm rim enhancing mass located in the left floor of mouth. The mass is medial to the left hyoglossus muscle and extends to midline. The posterior aspect of the mass effaces the left lateral aspect of the tongue base. The inferior aspect of the mass is superior to the mylohyoid muscle. The superior aspect of the mass is below the mucosal surface of the floor mouth. There is relative preservation of the fat planes. There is no evidence of obstructive sialadenitis involving the left submandibular gland.

There is an ill-defined oval enhancing mass that is anterolateral to the ring-enhancing lesion that measures approximately 1.3cm x 1cm. This may represent a focal area of sialadenitis versus enlarged sublingual space lymph node.

There is prominence of the adenoidal tissue involving the nasopharynx and tonsil which can be normal for this age.

Imaging of the neck demonstrates no evidence of enlarged lymph nodes given standard accepted size criteria.

Incidental note is made of an approximately 9mm cyst involving the posterior soft tissues of the neck which is likely due to a sebaceous cyst.

The visualized portion of the brain is grossly within normal limits. However, dedicated brain imaging is necessary for complete diagnostic evaluation.

Visualized portion of the lungs is affected by motion artifact and dedicated chest CT is necessary for complete diagnostic evaluation.

Conclusions
1. Approximately 3cm x 2cm ring-enhancing mass involving the left floor of the mouth that would be most consistent with abscess in a patient with fever. This could also represent an infected epidermoid.