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FIG 4. Case 4.

A, Axial contrast-enhanced CT scan obtained through the oropharynx shows asymmetry of the parapharyngeal space, which was thought to be a result of surgery.

B, Axial contrast-enhanced CT scan obtained 3 months later shows an enlarged retropharyngeal lymph node with central necrosis (arrow) and involvement of the right ICA (arrowheads).