Emily Skelton

Fibromatosis colli: The sternocleidomastoid pseudotumour of infancy

A 24-day-old male infant was referred from the GP for further evaluation of a unilateral neck mass. Initial examination identified a firm lump, apparently attached to the underlying sternocleidomastoid muscle in the right neck. The infant appeared to hold his head to the left, and movements seemed restricted. He was otherwise well, with no evidence of fever or pain. No other neck lumps or lymph nodes were identified on physical examination. A provisional diagnosis of swelling of the sternocleidomastoid was made, secondary to a history of difficult forceps delivery in theatre. Differential diagnoses included haematoma or lymphadenopathy. Ultrasound evaluation of the neck mass was performed using a high-resolution linear array transducer. The ultrasound examination identified a 38 × 14 mm nonvascular, predominantly hypoechoic mass within the anterior right neck. The swelling appeared mildly heterogeneous but isodense to the muscle, with an internally striated echopattern. It was spindle-shaped and was noted to taper caudally and cranially in continuity with the sternocleidomastoid (Fig. 1). The rest of the infant’s neck was unremarkable. The left sternocleidomastoid appeared normal, and no enlarged cervical nodes were demonstrated (Fig. 2). The sonographic findings

A post-traumatic pulsatile nodule in the right pre-auricular region

A 48 year old window fitter was referred directly from his general practitioner to the maxillofacial department with an eight week history of a painless, slowly enlarging nodule in his right pre-auricular region. He had noticed the lump shortly after a minor bump on his head at work. He was otherwise fit and well. Clinical examination confirmed a 10 mm firm and pulsatile nodule in the pre-auricular region. It was non-tender and non-fixed. Differential diagnoses included epidermal inclusion (sebaceous) cyst and lipoma. However, given his history of minor trauma, the maxillofacial team requested an ultrasound examination to confirm the nature of the lesion before further intervention. Duplex ultrasound examination of the right pre-auricular region showed a pulsatile nodule adjacent to the superficial temporal artery and right parotid gland that contained turbulent arterialised blood flow. Tortuous afferent and efferent arterialised vessels were also seen adjacent to the parotid gland. ### 1. What are the differential diagnoses for a pulsatile mass in this location? #### Answer A pseudoaneurysm of the superficial temporal artery, true aneurysm, arteriovenous malformation, vascular tumour, and mass overlying the artery with transmitted pulsations. #### Discussion From clinical assessment and duplex ultrasound examination, the patient was diagnosed as having a pseudoaneurysm of the right superficial temporal artery. Duplex ultrasound examination of the right pre-auricular region (fig 1⇓) showed a nodule of pulsatility adjacent to the superficial temporal artery and right parotid gland. Fig 1 Duplex ultrasound image of the right pre-auricular region showing a hypoechoic mass (arrowheads) containing central turbulent arterialised blood flow (C). Tortuous afferent (A) and efferent (B) arterial vessels are seen lying adjacent to the right parotid gland (P). The anatomical location of the vessels makes them consistent with the superficial temporal artery …

Comparison of the number of thyroid nodule FNAs one year before and after recommendations to report radiological incidentalomas

Aim To determine the number of FNAs performed one year before and one year after recommendations. Determine the number incidentalomas and the originally modality where they were detected. Determine whether there was a significant increase in the number of concerning lesions found, whether more operations were performed and whether there was any benefit for patients. Also, to study the relationship between the Thy3 lesions and number of follicular carcinomas..

Myoepithelial carcinoma of the parotid: a rare tumour that may provide diagnostic difficulty

This report presents the case of a 57-year-old man with a 6-week history of a slowly enlarging lump in the right parotid gland. Initial ultrasound investigation confirmed a 3 cm solid mass located within the superficial lobe of the right parotid gland. Sonographically, the mass demonstrated possible malignant features with internal heterogeneity of architecture and some loss of marginal clarity. Ultrasound-guided core biopsy (USCB) of the mass reported a mixed neoplasm with epithelial and myoepithelial appearances consistent with likely benign adenoma or myoepithelioma. A right superficial parotidectomy was subsequently performed. Histological and immunohistochemical analysis of the excised specimen showed a myoepithelial carcinoma. Postoperative CT and MR staging scans did not show evidence of metastases and no further treatment was given following discussion of the case at the regional speciality multidisciplinary meeting. This case illustrates the clinical and pathological features of this rare salivary gland tumour, but also discusses the diagnostic difficulties that may be encountered preoperatively.

Axial T2 weighted magnetic resonance image at the level of the lateral ventricles

Name the structures labelled A, B, C, D, and E in this axial T2 weighted magnetic resonance image at the level of the lateral ventricles⇓. What is the clinical significance of the structure labelled E?

Coronal T2 weighted image of the right iliac fossa from a magnetic resonance enteroclysis study.

Name the structures A, B, C, D, and E in this coronal T2 weighted image of the right iliac fossa from a magnetic resonance enteroclysis study⇓. What is magnetic …

Axial T1 weighted magnetic resonance image through the upper thorax in a 20 year old woman

Identify the structures A, B, C, D, and E in this axial T1 weighted image through the upper thorax of a 20 year old woman⇓. What …

Axial post-contrast computed tomogram at the level of the aortic arch

Identify the structures labelled A, B, C, D, E, and F in this axial post-contrast computed tomogram at the level of the aortic arch⇓. What is the clinical significance of the …

A man with a palpable abdominal mass and night sweats.

A 78 year old man presented with an eight week history of left sided abdominal pain and back pain, associated with anorexia, 3 kg weight loss, and night sweats. He was previously well, had no medical history of note, was taking no regular drugs, and was an ex-smoker. On physical examination, he was afebrile, baseline observations were normal, and peripheral pulses were present. Cardiorespiratory assessment was unremarkable. His abdomen was soft, but there was a tender non-pulsatile palpable central mass at the level of the umbilicus. Blood results showed a normochromic, normocytic anaemia with haemoglobin 92 g/L (reference range 130-180), erythrocyte sedimentation rate 75 mm in the first hour (0-22), and C reactive protein 15 mg/L (<3; 1 mg/L=9.52 nmol/L). Initial chest and abdominal radiographs showed no abnormalities so a computed tomogram of the abdomen and pelvis was performed (fig 1⇓). Fig 1 Axial contrast enhanced computed tomogram at the level of the iliac crest ### 1. What does the computed tomogram show? #### Short answer The computed tomogram shows aneurysmal dilation of the abdominal aorta, with a thickened …