Left neck mass x 2 years. Additional history from the electronic medical record: history of posterior neck schwannoma resection who presents for evaluation of left neck mass. The patient has had a left neck mass for at least 4 years. Recently, over the last 3-4 months, it has been growing in size. C-spine MR on 2/2016 demonstrated a 5 cm cystic/solid mass in the left neck which measured 1.3 cm on imaging on 10/2009. The patient underwent a CT on 3/15/2016 which demonstrated a 5 cm left neck mass, possibly representing a schwannoma or paraganglioma. There is a T2 hyperintense, tubular structure in the left neck abutting the left internal jugular and left common carotid artery measuring 1.9 x 1.4 x 4.9 cm. This lesion demonstrates minimal peripheral enhancement, with what appears to be a more nodular enhancing component along the superior and posterior aspect of the lesion, which measures 15 mm in diameter. There is otherwise no significant lymphadenopathy according to radiological criteria. The thyroid is not well-depicted, but there may be a small left upper lobe nodule. The imaged intracranial contents are unremarkable. The salivary glands and upper aerodigestive tract appear unremarkable. There is mild bilateral maxillary sinus mucosal thickening. The orbits are unremarkable. The cervical spine is unremarkable. However, there appears to be focal volume loss of the right spinal cord at the C2 level.
1. A left neck tubular cystic structure along the carotid sheath with a nodular solid component posteriorly and superiorly may represent a partially cystic peripheral nerve sheath tumor or cystic metastasis, perhaps related to a left thyroid malignancy. A thyroid ultrasound may be useful for further evaluation.2. Apparent focal volume loss of the right spinal cord at the C2 level may represent myelomalacia. Correlation with dedicated imaging of the cervical spine may be useful.