 There is an ill-defined transspatial lesion involving the soft tissues of the face extending posteriorly to the left parotid gland, anteriorly involving the left buccal space space and lips and medially into the left masticator space where there is enlargement of the left masseter muscle. Abnormal signal is also noted to involve the left pterygoid musculature as well as the left aspect of the hard palate. Extension into the left inferior lateral aspect of the extraconal left orbit is also noted. Superiorly signal abnormality involving the left temporalis muscle is also noted. No mass effect on the globe.This finding was partially seen on noncontrast CT from 8/14/2013. There is T2 hyperintensity involving the lesion and enhancement. Two foci of calcifications are noted within the lesion which may represent phleboliths. No discrete fluid collections or abnormal enhancement to suggest abscess.Small scattered left-sided cervical lymph nodes. Left submandibular gland is asymmetrically larger which is nonspecific. Visualized brain parenchyma demonstrates scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. No evidence of intracranial mass effect or herniation.
Extensive transspatial mass involving the soft tissues of the face including the left masticator space, buccal space, parotid space, as well as medial extension to involve the left hard palate and inferior lateral aspect of the left orbit. No prior MRI is available for direct comparison although the lesion is present on prior CT from 8/14/2013. Phleboliths are also suspected based on prior CT. Overall findings are favored to represent a venous malformation.Due to this extensive abnormality, underlying superimposed lesions are difficult to detect. There is however no appreciable evidence of an inflammatory process or fluid collections to suggest abscess. There is asymmetric prominence of the left-sided cervical lymph nodes which are not pathologically enlarged and nonspecific.