PMC6243361_01
Axial T1 weighted MRI with contrast and fat suppression. Displacement of the internal carotid artery anteriorly (red arrow head) with the internal jugular vein pushed posteriorly (white arrow).
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fig1
Characteristic splaying of the carotid artery and internal jugular vein (Figure 1), as well as typical contrast enhancement with flow voids suggested a vagal paraganglioma (VPG) with a less likely differential diagnosis of schwannoma.
Coronal MRI short tau inversion-recovery sequence (STIR) demonstrating a right-sided carotid space mass of intermediate low signal (white asterisk) with an abnormal lymph node (red arrow) showing signal intensity similar to the mass. A contralateral normal lymph node is shown for comparison (blue arrowhead).
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fig2
In retrospect, these nodes had similar signals and enhancement as the primary tumour (Figure 2).
PMC6243361_02
Axial CT scan showing a large pathological submandibular lymph node with heterogeneous internal density (white arrow).
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fig3
CT suggested soft tissue recurrence lateral to the mandible as well as an enlarged left level 1b submandibular node with heterogeneous internal density (Figure 3).
PMC6243361_03
Coronal T1 weighted fat-saturated contras-enhanced image shows an enhancing olfactory neuroblastoma in the inferolateral wall of the right maxillary sinus (white arrows).
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fig4
Her initial MRI demonstrated the primary tumour as a large, destructive mass in the right maxillary sinus (Figure 4).
Axial CT with contrast demonstrating abnormal, hyperenhancing right levels 1B and 2 lymphadenopathy (white arrows).
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fig5
Restaging CT scan of the neck at 12 months showed hyperenhancing cervical lymphadenopathy (Figure 5).