Wk 10, Case 1 - Review

Patient History
Afebrile 6-year-old male with right cheek mass within intact facial nerve.
Findings
Contrast-enhanced CT was performed from the skull base to the thoracic inlet. Study shows no evidence of aggressive lesions involving the nasopharynx, oral cavity, tongue base, tonsils, larynx or hypopharynx. No evidence of enlarged lymph nodes using standard size criteria.

There is an approximately 1.9 cm x 1.6 cm (axial dimensions) cystic mass involving the right parotid gland. The mass involves the midportion of the right parotid gland and extends superiorly to the junction of the membranous and bony external auditory canal. A component of the mass extends superiorly deep to the pinna and abuts the outer margin of the mastoid air cells. Bone algorithm suggests possible regressive remodeling involving the superolateral bony wall of the external auditory canal. The majority of the mass is intraparotid and involves both the superficial and deep lobe. There is no evidence of extension of the mass to the skin which would suggest a sinus.

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 grossly within normal limits. However, dedicated chest CT is necessary for complete diagnostic evaluation.

Conclusions
Approximately 1.9 cm x 1.6 cm cystic mass involving the right parotid gland that extends superiorly and abuts the bony cartilaginous junction of the external auditory canal. In an afebrile patient within intact facial nerve, these findings are most consistent with a type 1 first branchial anomaly.