Right parapharyngeal mass, possibly right paraganglioma: evaluate extent of mass to vessels. MRI: There is a heterogeneous right parapharyngeal mass that measures up to approximately 25 mm. The mass appears to encase the right internal carotid artery, which is slightly narrowed. The mass also compresses the right internal jugular vein. The mass appears to be distinct from the deep lobe of the parotid gland. There are multiple enlarged right cervical lymph nodes, involving levels 2 through 5. For example, a right level 2B lymph node measures 17 x 24 mm. There is asymmetric enlargement of the right palatine tonsil with an apparent mass that measures up to approximately 10 mm in width. The nasopharynx, hypopharynx, and larynx appear to be intact. The thyroid and salivary glands appear unremarkable. There is multilevel degenerative spondylosis with mild spinal canal stenosis from C4 to C7. The orbits are unremarkable. There is mild bilateral maxillary sinus mucosal thickening. There is a cystic lesion in the left sella, which measures up to approximately 10 mm. MRA: Aside from mild narrowing of the right internal carotid artery due to encasement by tumor, the other major cervical arteries are patent.
1. A right parapharyngeal mass may represent an abnormal lymph node that encases the internal carotid artery, rather than a paraganglioma. Indeed, multiple right cervical lymph nodes are also pathologic.2. Asymmetric enlargement of the right palatine tonsil with what appears to be a mass may represent a squamous cell carcinoma, with metastatic disease to the right neck lymph nodes.3. A cystic lesion in the left sella measures up to approximately 10 mm. A dedicated pituitary exam may be useful for further evaluation.Discussed with Maureen Crowley at 4:35 PM on 10/22/15.