– Feels a lump in the neck when swallowing
In what space houses this lesion?
Mass in the right parapharyngeal space or deep part of parotid space. No parapharyngeal fat is visible, so either the lesion displaces the fat or it arises from it. It is certainly not from the carotid space, since the carotid arteries are displaced posteriorly. It is also not from the mucosal space since it compresses the lateral oropharyngeal wall, instead of arising from it.
Do you want further imaging to make a diagnosis and what?
MRI will provide you more details in head and neck lesions where the lesion arises from exactly, and what the origin is. MRI is made with T1, T2, and T1 with Gad and fat suppression.
What is your differential diagnosis?
Origin from deep parotid lobe, so DD benign or malignant salivary gland tumor, such as pleiomorphic adenoma, adenoid cystic of mucoepidermoid cell carcinoma. Radiologists are not good in differentiating benign from malignant lesions on MRI. Histopathology has to be done. DWI will help you a little, in that, malignant lesions have often lower ADC values, but also Wharthin tumors do so. DD rare schwannoma arises from V3 (mandibular nerve) in the true parapharyngeal space.
We performed ultrasound and cytologic punction. This turned out to be a fairly rare acinic cell carcinoma.
Malignant tumors of the salivary glands are well delineated and do not have to present as ill-defined lesions, nor have to have lymph node metastasis or perineural spread
– Heavy smoker
– Depressive syndrome
Found lying unconscious at home, in lateral position (opioid overdose)
Erythema and limited movement of the left shoulder
Blood test: CK 7949 u/l. Negative blood and aspiration cultures (no infection)
What do you see?
CT: Low attenuation area involving the posterior aspect of the deltoid muscle and the lateral aspect of the pectoralis major muscle. Superficial and deep fascia edema. No enhancing walls neither gas is seen.
MRI: Postcontrast T1FS images show hypointense unenhancing central muscle fibers surrounded by thick rim enhancement involving the posterior deltoid, teres minor, and pectoralis major muscles . Thickened and hyperenhancing adjacent fascia and reactive muscle edema are also noted.
What is the most likely diagnosis?
Rhabdomyolysis (type 2: myonecrosis)
– Injury to skeletal muscle that involves leakage of large quantities of potentially toxic substances into plasma.
– Type 1: homogeneous signal changes and contrast enhancement. Ischemic or reversible ischemic reaction.
– Type 2: homogeneous or heterogeneous signal changes and rim enhancement. Irreversible muscular necrosis (myonecrosis).
– Deep tissue injury: severe pressure ulcer, characterized by necrotic tissue mass under intact skin.
Enhancing mass in the left renal pelvis, most likely TCC
What is the treatment?
Left total nephroureterectomy and bladder cuff excision
Microscopy result: Transitional Cell Carcinoma of 2,5 cm in the renal pelvis, low grade.
TNM classification Pyelum-Ureter (8th edition UICC): pTa.
– The vast majority of renal pelvis and ureter tumours are transitional cell carcinoma (> 90%), the remainder of tumours are squamous cell carcinoma (< 10%) and adenocarcinoma (< 1%)
Transitional cell carcinoma much more commonly occurs in the bladder than in the renal pelvis or ureter
- Synchronous and metachronous tumours are frequent because TCC is caused by toxic exposure through for example cigarette smoking
- TCC of the renal pelvis can spread to the kidney and intraluminal seeding to more caudal parts of the ureter and to the bladder is common => always look for other space occupying lesions
– For these reasons, an excretory phase is always useful when a kidney mass is suspected, as TCC’s represent 10 to 15% of renal tumours
– Hemodialysis patient
– Presents with a very large scrotum, size of a football
– Patient is not sick, no fever
– Laboratory results are normal
– US: Incarcerated inguinal hernia? Hydrocele? Malignancy?
What is the most likely diagnosis?
Diagnosis: Extensive scrotal lymphoedema
– Extensive scrotal wall thickening associated with diffuse lymphoedema extending to the base of penis not involving the penile corpora
– No extension into the deep subcutaneous tissue planes, inguinal canal, or muscles
– No extension to the groin or lower abdomen
– No inguinal adenopathy
– Both testicles are morphologically normal with no associated hydroceles
– There is no associated soft-tissue mass
Vertebral hemangioma with thickened trabeculae and fat foci inside the lesion, without soft tissue component with an associated pathological fracture.
Bone hemangiomas are very frequent, atypical presentations and complications (like in this cases with soft tissue component and pathological fracture) are rare but radiologist must be aware of them to be able to make the correct diagnosis.