55-year-old male presented with mass in the right neck parapharyngeal. Please evaluate.Technique: Following the administration of 70 mL Omnipaque 3501.Contiguous axial images were obtained through the soft tissues of the neck. Sagittal and coronal reconstructions were performed.2.Contiguous axial images were obtained of the brain. There is a 3731 mm axial dimensions mass measuring 50 by a 34 mm and coronal dimensions which surrounds the styloid process on the right side. It is heterogeneous in appearance. It displaces the right submandibular gland inferiorly and a displaces the right tap mylohyoid muscle medially. It abuts the right mandible at the angle of the mandible and also is visually contiguous with the right carotid space and displaces the right carotid artery and right external carotid artery posterior lateral. The styloid process extends into this mass along its more superior aspect. This is centered in the right parapharyngeal space and visually contiguous with the right masticator space. Its density is a lower than that of muscle and higher than that of CSF. It appears to be well circumscribed and a is not associated with bony erosion. There is a vessel which appears to run through it and best seen on the recent MRI images along its inferior and posterior aspect which most likely represents the facial arteryAt the level of the right bone and just above now within the preepiglottic space and there is a 16 x 23 mm irregular shaped lesion which appears to be visually contiguous with the tongue base and contains a number of air bubbles at appearedWithin the right submandibular space anteriorly there is a 12-mm nodule present better seen on the recent MRI than on the CT scan which showed abuts and is visually contiguous with the mylohyoid muscle. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact with displacement of the right submandibular gland as indicated above.The visualized lung apices appear clear with some emphysematous changes.The carotid and vertebral vasculature visualized on this exam appears intact with displacement of the right carotid vessels as indicated above.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are degenerative changes in the cervical spine with endplate and uncovertebral osteophytes and narrowing the neural foramina on the left side at C3-4 and bilaterally at C5-6. There is semi-disk disease also present in the cervical spine as well.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.No abnormal enhancing lesions are appreciated in the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is a new right to masticator space and parapharyngeal space mass as described above which appears well circumscribed. malignancy such as squamous cell carcinoma cannot be excluded. Schwanoma and nerve sheat tumors may have this appearance. Salivary gland neoplasm is also consideration. 2.There is a nodule present along the right submandibular space is indicated above better seen on the recent MRI exam . This is suspicious for lymphadenopathy3.there is an exophytic mass along the tongue base which projects into the preepiglottic space. The possibility this represents a neoplasm is raised. Please correlate with physical findings on clinical exam.4.Degenerative changes are present in the cervical spine as indicated above.