Date : 00.00.00
Name of the Patient : Abc Xyzant Palmn / M / 45 yrs.
Referred by : Dr. Abc Xyzthare.
Examination : M.R.I. of the Neck.
CLINICAL PROFILE :
H/O teeth extraction from the right lower jaw since 3 months with progressive swelling and pain below the right ear and neck since then.
M.R.I of the neck was performed using the following parameters :
6 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.
6 mm thick T1 Weighted and STIR coronal images.
6 mm thick T1 Weighted and Gradient sagittal images.
There is a large well-defined mass lesion which measures 7.0 x 7.0 x 11.5 cms and is located in the right submandibular space and the sublingual region. This lesion is seen to engulf the ramus of the mandible and extends superiorly on either side of the body of the mandible. The medial portion of this lesion displaces the oropharynx to the left and the mid and posterior aspect of the tongue to the left and superiorly. Postero-medially the right carotid sheath is pushed posteriorly. The vessels however show normal flow void signal on all the pulse sequences. Laterally the lesion is seen to extend lateral to the mandible upto the subcutaneous region without any obvious destruction or erosion. Inferiorly this lesion is seen to extend till the D1 vertebral level. The submandibular gland cannot be well identified separately from the lesion. The adjacent muscles are displaced to the periphery of this lesion with few of them showing altered signal on the T1 Weighted images which may
represent edema. This lesion has mixed signal characteristics with a predominant portion being hypointense on the T1 Weighted images and which turns heterogeneously hyperintense on the T2 Weighted and STIR images.
Few hyperintense areas are seen within this lesion on the T1 Weighted images which are seen to turn hypointense on the T2 Weighted and STIR images and bloom on the gradient images and represent paramagnetic substances/calcification. Few hypointense areas on the T1 Weighted images are also seen in this lesion and which are seen to turn hyperintense on the T2 Weighted and STIR images and may represent cystic/necrotic changes. Small curvilinear flow void areas are noted within this lesion on all the pulse sequences representing blood vessels. Septae (hypointense on all the pulse sequences) are noted within this lesion.
No obviously enlarged lymphnodes are evident on this scan. The vascular structures in the neck on the left side are unremarkable.
The cervical spine shows mild degenerative changes with small posterior disc bulges at the C3-C4, C4-C5 and C5-C6 levels.
A large mass lesion measuring approximately 7.0 x 7.0 x 11.5 cms in the right submandibular space and the sublingual region as described. This is not specific for a single diagnosis.
The possibilities to be considered are :
1. A nerve sheath tumor.
2. Other neoplastic processes (eg. salivary gland tumors).
3. Infective processes.
A contrast enhanced scan may be worthwhile.