Presentation
Swelling in the right submandibular region for 3 years.
Patient Data
Transverse and longitudinal greyscale and color Doppler ultrasound images showing a heterogeneously hypoechoic well-defined lesion with moderate internal vascularity. The lesion is compressing the ipsilateral submandibular gland. The elongated medial border of the lesion is probably due to an entry point of a nerve.
T1 isointense, T2/STIR heterogeneously hyperintense oval-shaped well-circumscribed lesion measuring approximately 3.4 x 2.6 cm in the right submandibular space causing compression and posterolateral displacement of the submandibular gland.
Moderate enhancement on the postcontrast study. No diffusion restriction.
Case Discussion
MRI imaging reveals a T2 heterogeneously hyperintense lesion with internal areas of low signal areas giving rise to a fascicular pattern typical for nerve sheath tumors. The lesion has a T2 hypointense capsule. The ipsilateral submandibular gland is compressed and displaced posterolaterally. The postcontrast study shows moderate enhancement, with no restriction on DWI.
On US correlation, the lesion appears heterogeneously hypoechoic with moderate internal vascularity on the color Doppler study. US demonstrates an entry of a nerve into the lesion, which is probably the hypoglossal nerve.
On biopsy, it was confirmed to be a schwannoma.
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