Submandibular region painless swelling since 9 months. On examination, bluish submucosal swelling seen in the right half of floor of mouth
MRI head and neck
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Fluid collection is seen epicentered in right sublingual space extending posteriorly beyond mylohyoid into the submandibular space and superiorly into right parapharyngeal space along the lateral margin of right tonsil.
T2 hyperintense, T1 iso to hyperintense fluid with thin septae and facilitated diffusion. Minimal septal enhancement.
No extension into other neck spaces.
Findings in keeping with a diving or plunging ranula. The long standing inspissation / retention of fluid is responsible for the higher T1 signal. The extension to the typical submandibular and parapharyngeal spaces favor a diagnosis of ranula.
In the absence of an oral component, the next differential in line would be a cystic hygroma.
- Macdonald, Andre J., Karen L. Salzman, and H. Ric Harnsberger. "Giant ranula of the neck: differentiation from cystic hygroma." American journal of neuroradiology 24.4 (2003): 757-761. Pubmed citation