Radiology Quiz Case 3

Abstract

A 28-YEAR-OLD WOMAN PRESENTED WITH A 6-month history of a visible mass at the base of her tongue. In addition to a lifelong history of loud snoring with occasional gasping, she reported shortness of breath, which was worse when she was lying flat. She also reported a chronic cough and a history of weight gain. She denied having otalgia, odynophagia, dysphagia, change in voice, or stridor. Physical examination revealed an obese, nonstridorous woman. Oral cavity examination revealed macroglossia with a surgical absence of palatine tonsils. There was a large lingual tonsillar mass that became more prominent with tongue protrusion and was more prominent on the right side than on the left. The findings of the neck examination were unremarkable. Flexible nasolaryngoscopy revealed a base of tongue and vallecular mass completely filling the vallecula and pressing the epiglottis posteriorly. The vocal folds were normal in appearance and moved symmetrically. Contrast-enhanced computed tomographic sections revealed a nonenhancing lingual tonsillar mass that was larger on the right than on the left as well as several enlarged, noncystic level 2 lymph nodes in the right side of the neck (Figure 1). The mass, which measured approximately 4.8 3.2 4.2 cm, extended to the epiglottis and filled the vallecula. The largest lymph node, which was seen on the right in level 2b, measured approximately 1.6 cm. On coronal sections, the mass was observed abutting the inferior surface of the right soft palate superiorly (Figure 2). There was no other evidence of neck adenopathy. The nasopharynx, hypopharynx, larynx, and subglottic airways were unremarkable, as were the parotid, submandibular, and thyroid glands. The piriform sinuses and vocal cords were normal. What is your diagnosis?