Tumefactive Fibroinflammatory Lesion of the Neck with Progressive Invasion of the Meninges, Skull Base, Orbit, and Brain
Andrei I. Holodnya,
Claudia F. Kirscha,
Meera Hameeda and
Gary Sclar
,a
a From the Departments of Radiology (A.I.H., C.F.K), Pathology (M.H.), and Neurosciences (G.S.), New Jersey Medical School, Newark, NJ.
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FIG 1. 23-year-old man with 2-year history of trismus and dysphagia. A–C, Imaging studies at the time of the first admission. A, Axial contrast-enhanced CT scan through the neck at the level of the tongue and the submandibular triangle. The mildly enhancing lesion has infiltrated into the left carotid space (curved arrow) and the left submandibular triangle (straight arrows). B and C, Coronal contrast-enhanced T1-weighted (600/14/1) (B) and axial T2-weighted (4000/105/1) (C) MR images show infiltration by the lesion of the left nasopharynx (wide arrow). It invades into the left middle cranial fossa and the left cavernous sinus (double arrows) through the foramen ovale (single arrow). It is mildly enhancing on the T1-weighted image and is hypointense on the T2-weighted image. The lesion replaces adipose tissue in the left parapharyngeal space. fig 2. Contrast-enhanced CT study at the time of the second admission shows thickening and enhancement of the tentorium cerebelli, greater on the left (arrows). This finding was not seen previously
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FIG 3. A–E, Imaging studies at the time of the third admission. A and B, Coronal T1-weighted (600/23/1) (A) and coronal contrast-enhanced T1-weighted (500/14/1) (B) MR images show that the lesion has progressed to involve the contralateral cavernous sinus and the meninges of the right cranial fossa (double arrows, B). The lesion significantly narrows the right cavernous carotid artery and has invaded the right masticator space from the right middle cranial fossa through the foramen ovale (single arrow, B). The unenhanced image shows that the lesion has replaced the normally seen adipose tissue in the right infratemporal fossa. C–E, Coronal T2-weighted (4000/102/1) MR image (C) shows abnormal signal intensity in theright temporal lobe, which involves both the gray and white matter. Axial fat-suppressed, contrast-enhanced T1-weighted (600/20/1) MR images (D and E) show marked thickening and enhancement of the meninges of the right middle cranial fossa extending into the sulci as well as wisps of enhancement of the temporal lobe itself. There is marked narrowing of the cavernous carotid artery. The right lateral rectus muscle is enlarged and enhancing more than the other extraocular muscles, indicating probable involvement by the lesion
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FIG 4. Coronal contrast-enhanced T1-weighted (500/5.7/1) MR image at the time of the fourth admission shows a large right convexity subdural hematoma (arrow), leading to a large midline shift
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