Isolated submandibular extravasation - pseudocyst

Case contributed by Dr Varun Babu

Presentation

Soft tissue neck mass for assessing extent and possible differentials

Patient Data

Age: 18 years old
Gender: Male

MRI neck

Modality: MRI

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. 

Case Discussion

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.

Differentials in view of the morphology would include cystic hygroma and lymphangioma.  

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Case Information

rID: 45903
Case created: 13th Jun 2016
Last edited: 13th Jun 2016
System: Head & Neck
Inclusion in quiz mode: Included

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