PMC5787655_01
Coronal CT scan, demonstrating cystic lesion over the left side of the neck.
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F1
Flexible nasopharyngolaryngoscopy revealed slight fullness and medialization of the left pyriform fossa, with the epiglottis displaced to the right side.A computed tomography (CT) scan of the neck (Fig. 1) showed a cystic lesion over the left side of the neck, extending from the hyoid bone superiorly to the inferior border of the thyroid cartilage.
Multiplanar (coronal, sagittal and axial) and MIP images on CT and PET/CT (upper row) and on PET (lower row) demonstrating a subtle enlarged left thyroid lobe from a heterogenous enhancing lesion seen on CT. The lesion corresponds with high 18F-FDG intensity uptake
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F2
An 18F-FDG-PET CT scan (Fig. 2) demonstrated a large focus of a high-intensity 18F-FDG uptake in the left thyroid lobe.
PMC5787655_02
Axial CT scan of the neck at the level of hyoid bone demonstrating ill-defined low attenuation rounded lesions with thick wall in the anterior neck
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F3
A CT scan (Fig. 3) confirmed a midline cystic mass measuring 4.1 x 4.7 x 5 cm within the subcutaneous tissues and left strap muscles, but separated from a normal-looking thyroid gland.
PMC5787655_03
Axial CT scan of the neck demonstrating multiple cervical lymph nodes, with normal-looking thyroid gland.
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F4
A CT scan (Fig. 4) of the neck revealed multiple cervical lymphadenopathy bilaterally, with the largest measuring around 1.6 x 1.4 cm located at the right posterior cervical chain, which was enhancing the central necrosis.
Reconstructed integrated PET/CT of the neck in sagittal (right) and axial (left) plane. Images demonstrated a focus of high 18F FDG uptake in the right lobe of the thyroid gland
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F5
The investigation proceeded with an 18F-FDG-PET CT scan (Fig. 5), which showed an increased FDG uptake in the superior part of the right thyroid lobe and the right-sided neck lymph nodes at levels III and IV.