Left buccal angiosarcoma.Additional history from EMR: submucosal lesion of the left buccal mucosa inferior to the punctum of the salivary gland. It is non-friable. It seems to be adherent to the mucosa but is slightly pigmented and firm, measuring about 1 cm in greatest dimension. 3/10/16, wide local excision of left buccal lesion with primary closure. Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered T2-hyperintense foci in the cerebral white-matter. There is also symmetric globular T2-hyperintensity in the globi pallidi. The brain parenchyma and pituitary gland appear unremarkable otherwise. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact accounting for hypoplastic right vertebral artery, small right internal carotid artery and probably absent right A1 segment. There is mild ethmoid mucosal thickening. Globes show very mild staphylomas, which can be associated with myopia.Neck:The patient was imaged deeply sedated and the study is at least mildly limited by patient breathing motion. There is asymmetric increased STIR signal and contrast enhancement in the left posterolateral buccal mucosa but no discernible mass (15/23-27). These findings are nonspecific and may relate to recent tumor resection. There is no significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are grossly unremarkable. The major cervical vessels are patent accounting for a nondominant right vertebral artery. An artificial airway is present in the oral cavity/oropharynx. Otherwise, the airway is patent. There are findings of remote internal fixation of right clavicle fracture with associated susceptibility. There are bilateral injectable facial fillers.
1.The patient was imaged deeply sedated and the study is at least mildly limited by patient breathing motion. 2.No brain metastasis. A few T2-hyperintense lesions in the cerebral white-matter are nonspecific but may represent chronic microvascular ischemia.3.Symmetric T2-hyperintensity in the globus pallidi may represent sequela of prior metabolic injury.4.Asymmetric contrast enhancement and STIR signal in the left lateral buccal region without discernible mass is nonspecific and may reflect postoperative change. No discrete mass or cervical lymphadenopathy.