Presentation
Left neck lump
Patient Data
The mass is oval, sharply circumscribed, and heterogeneous centrally, with a thick irregular peripheral pattern of enhancement, and either necrotic or partially cystic core. 26 x 31 x 38 mm, the lesion lies deep to the left sternocleidomastoid, displaces the common and internal carotid arteries medially, compresses the jugular vein although is separate from it, and could best be characterized as a carotid space mass.
Superiorly it reaches to the deep lobe of the left parotid gland, inferiorly for 3.8 centimeters. Surrounding fat planes are normal.
There are numerous enlarged lymph nodes along the jugular chain bilaterally, the largest at the jugulodigastric level on each side-on the right and 12 and 11 mm in diameter respectively, and on the left 15 mm long axis. None of the nodes have high risk morphology in terms of necrosis or infiltration of surrounding tissues.
Conclusion:
The most likely diagnosis is of a nerve sheath tumor-with reactive but not malignant numerous bilateral jugular chain lymph nodes.
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