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Wk 10, Case 3 - Review

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Report

Patient History
20-year-old male with fluctuating tongue mass.

Findings
Pre- and postcontrast-enhanced MR was performed of the maxillofacial region along with contrast-enhanced MR angiogram. The study demonstrates an approximately 2.4cm (AP) x 2.3cm (TRV) x 2.8cm (CC) mass involving the right half of the oral tongue. The coronal images demonstrate the mass to extend to the midline lingual septum and may slightly cross midline.

The lesion is high signal on T2, low signal on T1 and demonstrates delayed enhancement best appreciated on the sagittal time resolved angiography. The T2 weighted images demonstrate multiple areas of signal loss within the lesion which are suspicious for phleboliths.

The diffusion-weighted images demonstrate increased signal; however, the ADC map shows no evidence of restricted diffusion. This makes the diagnosis of epidermoid less likely.

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

Conclusions
Heterogeneous mass involving the right half of the oral tongue which is high signal on T2, contains multiple focal areas of decreased attenuation and demonstrates delayed enhancement on the time resolved angiography. The above findings are most consistent with a venous malformation involving the oral tongue.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Suresh K Mukherji, MD, FACR, MBA

Clinical Professor, University of Illinois & Rutgers University. Faculty, Michigan State University. Director Head & Neck Radiology, ProScan Imaging

Tags

Neuroradiology

MRI

Head and Neck

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