Diagnosis: Localized swelling, mass and lump, head Essential (primary) hypertensionDiagnosis Edits: |Clinical question: HISTORY OF RIGHT MANDIBLE MASSSigns and Symptoms: HISTORY OF RIGHT MANDIBLE MASS Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.There is a mass centered in the right mandible associated with contrast enhancement and some mild enlargement. There is disruption of the cortex along the right anterior lateral aspect of the mass with some mild protrusion of the mass through this defect. Masses high signal on T2 and low signal on T1 and without diffusion restriction. No flow voids are identified within the mass to suggest arteriovenous malformation.Within the visceral space the thyroid gland demonstrates multiple small nodules the largest one of which measures 9 x 12 mm axial dimensions. It is high signal on T2 and relatively lower signal on T1. The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. There are patchy high signal foci on T2 imaging in the brainstem which are most likely vascular related. 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.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are multilevel degenerative changes present in the cervical spine with reversal of the normal cervical curvature at C3-4, loss of disc space height, disc desiccation and endplate and uncovertebral osteophytes resulting in encroachment of right-sided exiting nerve roots at C6-7 and C5-6 and some narrowing of the spinal canal due to endplate osteophytes at C3-4, C4-5 and C5-6 .MRA neck:The right inferior alveolar artery is asymmetrically larger than the left side and courses along the superior aspect of the mass. No convincing evidence for arteriovenous malformation. The anterior aspect of the mandible was not included on this exam.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is fetal origin of the right posterior cerebral artery.
1.An expansile mass along the right mandible suspected represent a hemangioma. There is a small amount of extraosseous extension along the right anterolateral aspect of the mass. However, the entire mandible was not included on the MR angiogram. As a result of the convenience of the patient and noncontrast MRA of the mandible with specific attention this area would be helpful.2.Multiple thyroid nodules.3.Multilevel degenerative changes are present in the cervical spine.