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头颈部病例76分析
A42-year-oldwomanpresentswithotalgia.42岁女性，耳痛。
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(A)T1-weightedaxialimagingrevealsandoralroundedmassatleftcarotidspacewithanteriordisplacementofleftcarotidartery(blackarrow).Asimilarsmallermassisalsoseenontherightside.(B)T2-weightedaxialimagingshowsprevioushyperintenseT2signalofthismass(blackarrow).(C)PostcontrastT1-weightedimagingrevealshomogeneouscontrastenhancement(blackarrow).(D)Postcontrastfat-saturatedT1-weightedimagingrevealsmarkedintensepostcontrastenhancement(arrow).Theright-sidedmassisnowmoreconspicuous.
(A)T1加权轴位成像示左侧颈动脉间隙有卵圆形肿块，伴有左侧颈动脉前移(黑色箭头)。在右侧也可见一个类似的较小肿块。(B)T2加权轴位成像示肿块呈T2高信号(黑色箭头)。(C)增强后T1加权成像示病灶均匀强化(黑色箭头)。(D)增强后脂肪饱和T1加权成像示增强后明显强化(箭头)。右侧病灶较前更加明显。
DifferentialDiagnosis
?Vagalschwannomaofcarotidspace:Rounded,smooth,well-defined,carotidspacemasswithanteriordisplacementofcarotidartery.Thereishomogeneousandintensepostcontrastenhancementwithlackofserpentinehighvelocityflowvoidareas.
?Glomusvagaleparaganglioma:Rounded,well-defined,hyperintenseT2signal,carotidspacemassisseenwithintensehomogeneouspostcontrastenhancement.Thereispresenceofserpentinehighvelocityflowvoidareas.
?Reactivelymphnodes:Commonlyseeninyoungerpatients.MultipleenhancingovoidlesionsareseenatcarotidspacesandretropharyngealspaceswithmoderatelyhighT2signalandmoderatepostcontrastenhancement.
鉴别诊断
?颈动脉间隙迷走神经鞘瘤：圆形、光滑、边界清楚，使颈动脉前移位的颈动脉间隙肿块。增强后明显均匀强化，无蛇形高速流空影。
?迷走神经副神经节瘤：圆形、边界清晰、高T2信号，颈动脉间隙肿块，增强后强化均匀。见蛇形高速流空影。
?反应性淋巴结：常见于年轻患者。颈动脉间隙和咽后间隙可见多个卵圆形强化病灶，中等高T2信号，增强后中度强化。
EssentialFacts
?Asmooth,well-marginated,benigntumorisseenoriginatingfromSchwanncellssurroundingthevagusnerveinthecarotidspaceoftheneck.
?Itismost
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