Left oropharyngeal tonsillar carcinoma with left cervical metastatic lymphadenopathy
Left neck swelling since 6 months. Medical treatment with antibiotics failed. The clinician was inquiring about a left parotid mass.
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Left palatine tonsil as well as left oropharyngeal wall well defined mass lesion is seen measuring 1.7 X 1.7 X 1.4 cm in orthogonal dimension causing oropharyngeal wall asymmetry with mild encroachment upon the oropharynx. This lesion elicits iso-intense T1, iso- to hyper-intense T2 and high STIR signals with intense peripheral post-contrast enhancement.
Multiple enlarged discrete irregular lymph nodes are noted in the left side of the neck deep to the sternocleidomastoid muscle all along its course as well as left intra-parotid lymph node and a lower neck posterior triangle lymph node and enlarged let submandibular lymph node. They elicit iso- T1 and hyper-intense T2/STIR signals with avid post-contrast enhancement. The largest of which is above hyoid bone level (level II) measuring 2.3 X 2.2 cm. The related overlying sternocleidomastoid muscle is seen bulky as well as related skin high T2/STIR signal and post-contrast enhancement.
Normal nasopharynx with intact para-pharyngeal fat planes.
Normal MRI appearance of the laryngeal cartilaginous framework with patent laryngeal and pharyngeal air columns.
Normal right parotid and both submandibular salivary glands.
Both lobes of the thyroid gland and the isthmus are of normal size. No evidence of focal nodules or masses.
Intact neck musculature on right side with preserved intermuscular fat planes.
Right sided mastoiditis.
Left oropharyngeal tonsillar carcinoma with left neck levels Ib, II, III, IV and V metastatic lymphadenopathy.
Necrotic heterogenously enhancing neck lymphadenopathy (particularly if unilateral) should prompt the meticulous search for a head and neck squamous cell carcinoma.
Examine the nasopharynx, oropharynx, palatine tonsils and the larynx as well as the thyroid.