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CT and MRI appearances of inflammatory pseudotumour of the cervical lymph nodes

Departments of ¹ Neuroimaging and ² Pathology, Kings College Hospital, Denmark Hill, London SE5 9RS, UK

View larger version (138K): [in a new window]   Figure 1. Axial CT post intravenous contrast (Somatom Plus 4, Siemens, Erlangen, Germany; slice thickness/slice spacing 5/10, 100 ml Omnipaque 300) at the level of the mandible demonstrates a confluent mass of enlarged jugular chain and posterior cervical level II and V lymph nodes.

View larger version (95K): [in a new window]   Figure 2. Neck MRI (Magnetom Harmony 1T; Siemens, Erlangen Germany). (a) Axial T2 turbo spin echo repetition time (TR)/echo time (TE) 4465/120) and (b) coronal short tau inversion recovery (TR/TE 4465/30) images through the neck show central homogeneously increased signal and peripheral lower intensity of the individual lymph nodes, with associated perinodal and sternocleidomastoid muscle hyperintensity consistent with extension of inflammatory infiltrate. Compared with the CT performed 3 months previously there has been some reduction in overall nodal bulk and extent of adjacent inflammatory change.

View larger version (133K): [in a new window]   Figure 3. Coronal T1 spin echo (repetition time (TR)/echo time (TE) 418/12) post gadolinium demonstrates peripheral enhancement of individual lymph nodes containing central low signal necrotic or cystic cavities, and extension of abnormal enhancement into the perinodal soft tissue and overlying sternocleidomastoid muscle.