MRI
Large well-defined lobulated mass (isointense to muscle on T1W and hyperintense to muscle on T2W) within the left post-styloid parapharyngeal space and carotid spaces, from the level of the jugular foramen superiorly to the level of C5/C6 inferiorly as seen on CT. It is heterogeneously enhanced with the central non-enhancing cystic component within, likely to represent central necrosis. No T1W hyperintensities or flow voids within suggest a “salt and pepper” appearance. No blooming artifacts were seen on gradient echo images to suggest intratumoural haemorrhage. It is causing a mass effect on the adjacent structures. It abuts the left prevertebral muscles; however, no abnormal signal or enhancement is seen within. This mass splays the internal carotid (ICA) and external carotid arteries (ECA) as well as displaces them anterolaterally. There is a complete (360-degree) encasement of the left common carotid (CCA), ICA, and ECA; however, these vessels still remain patent. On MRA, no significantly enlarged feeding vessels were demonstrated. The left internal jugular vein (IJV) is compressed. No intracranial extension.
Mild hyperintense signal is seen involving the left side of the tongue on T2W and STIR, with a dorsal bulge causing effacement of the left vallecula. The left aryepiglottic fold is mildly thickened with medial deviation.
Multiple subcentimetre-enhancing cervical nodes bilaterally, largest on the right.
The visualised brain parenchyma is unremarkable.