Isolated submandibular extravasation - pseudocyst
Soft tissue neck mass for assessing extent and possible differentials
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A predominant fluid signal intensity (T2 hyperintense T1 hypointense, facilitated diffusion) septated collection is seen occupying the subcutaneous plane of the left submandibular space overlying the submandibular gland with maximal dimensions of 7x6cm (TR x CC). Subcutaneously it just extends anteriorly to the midline and just crosses to the right. Deeply, it tracks lateral to the mylohyoid and deep to the mandible in the submandibular space and another limb posterior to the mylohyoid muscle extending superiorly and deep to the medial pterygoid. The septae show mild enhancement in post contrast study. No definite tail like communication is identified with the sublingual space. The Wharton duct per se is not dilated.
2 case questions available
Typically when such a large fluid collection is accompanied by a sublingual 'tail', a diagnosis of sublingual plunging ranula can be made. However, there are instances reported in literature where large isolated mucinous extravasations can occur confined and isolated to the submandibular space, which on infection or trauma, can give this sort of appearance.
- Gulati, Harveen K., et al. "Rare case of giant plunging ranula without intraoral component presenting as a subcutaneous swelling in the neck: A diagnostic dilemma." Journal of cutaneous and aesthetic surgery 5.3 (2012): 219. Pubmed citation
- Mohanty, Sujata, Ujjwal Gulati, and Sapna Singh Vandana. "A rare cause of lateral facial swelling." Annals of maxillofacial surgery 4.2 (2014): 230. Pubmed citation