MRI
Coronal T1
Coronal T1 C+ fat sat
Axial T2 fat sat
Coronal T2 fat sat
Axial DWI
Axial ADC
Axial T1
Axial T2
Axial T1 C+ fat sat
Coronal T2
Coronal abdominal scout
Coronal T2
A large fairly homogeneous mass is primarily localized to the mucosal space of the nasopharynx and oropharynx predominantly on the left extends beyond the pharynx into the parapharyngeal space on the left displacing internal carotid artery and external carotid artery posterolaterally and pushes the deep lobe of the parotid laterally.
Inferiorly the mass extends to the upper valleculae bilaterally and superiorly, it abuts the base of the skull and extends into the soft palate and across the midline. The mass is of homogeneous signal, avidly enhancing and demonstrates very low ADC values (500 x 10^-6 mm^2/s)
On the right and a similar appearing large jugulodigastric lymph node is present.
The abdominal x-ray obtained prior to MRI to exclude metallic foreign bodies (not shown) had an unusual contour and as a result and a single abdominal MRI scout and coronal T2 weighted scans were requested. These demonstrates a large lobulated retroperitoneal mass in the region of the pancreatic head.
Conclusion:
Large nasopharyngeal and oropharyngeal mass with right-sided nodal mass has signal and enhancement characteristics suggestive of an highly cellular tumor most likely lymphoma. This is supported by the presence of what appears to be a large retroperitoneal abdominal mass, which needs further assessment with CT/PET.