Neck mass. 37-year-old male. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and mastoid air cells are unremarkable.Images through the neck demonstrates a low-density mass with extensive internal vascular enhancement in left neck immediately posterior to the left carotid bifurcation. There is anterior displacement of distal left common carotid, proximal left internal and external carotid arteries. The mass measures 72 mm in cranial cephalad access and 42-mm x 38 0.7-mm in its axial dimension. On axial images a tapered cephalad extension of this mass reaches the anterior aspect of body of C1 vertebrae. Prior MRI examination demonstrated intense enhancement of this tumor however the enhancement on the CT examination is very patchy and not solid as it was noted on MRI. This mass demonstrates a very well demarcated margin and with no evidence of any edematous changes of adjacent fascia planes. There is significant mass-effect and lateral displacement of the left internal internal jugular which at the level of maximum compression is almost nondetectable. There is no evidence of encasement of the left carotid by this mass. Left internal jugular home for her superior and inferior to this tumor remains open.The differential for this tumor remains and is a chemodectoma, a schwannoma or a metastatic lymph node.A small right submandibular lymph node measuring 12 mm times 15-mm in transaxial dimension is present. This shows no enhancement or necrosis. Multiple smaller scattered nonenhancing and not a pathologic nodes are also noted.There is symmetrical prominence collecting tonsils with no enhancement or necrosis. Limited images of the apices of the lungs are negative for pathology.Limited images of the mediastinum are also negative. 70 cc of Omnipaque 350 was utilized for the above study.
1. Large well-demarcated low-density mass with patchy internal vascular enhancement in the left neck. Finding is believed to represent a schwannoma, additional possibility of chemodectoma, metastatic lesion cannot be entirely ruled out.2.Small additional nonenhancing and nonpathologic lymph nodes as detailed.3.Prominent adenoids and collecting tonsils with no abnormal enhancement.