Syncope as a Sign of Occult Malignant Recurrence in the Retropharyngeal and Parapharyngeal Space: CT and MR Imaging Findings in Four Cases
Mitsuhiko Nakahiraa,
Hiroaki Nakatania and
Taizo Takedaa
a From the Department of Otolaryngology, Kochi Medical School, Nankoku, Kochi, 783-8505 Japan
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FIG 1. Case 1. Axial T1-weighted contrast-enhanced MR image (350/8 [TR/TE]) obtained through the soft palate shows a mass (white arrow) that extends into the parapharyngeal space and encases the left ICA (black arrow). Note a rectus abdominal musculocutaneous flap (RA), which was used during previous surgery to reconstruct the defect caused by buccal cancer.
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FIG 2. Case 2. Axial T1-weighted contrast-enhanced MR image (600/20) shows a lateral retropharyngeal lymph node metastasis (white arrow) that surrounds the right ICA (black arrow).
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FIG 3. Case 3.
A, Axial contrast-enhanced CT scan obtained through the oropharynx shows asymmetry of the parapharyngeal space, which was believed to be a result of surgery. Note the low-attenuating area on the right half of the tongue that represents denervated muscle atrophy and increased fat after resection of the right hypoglossal nerve.
B, Axial T2-weighted MR image (3500/110) obtained 3 months later shows that an abnormal mass (white arrows) with intermediate signal intensity replaces most of the retropharyngeal and parapharyngeal spaces, with involvement of the right ICA (black arrow).
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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).
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AJNR - American Journal of Neuroradiology