Case 5

This is an MRI study of the neck – the salient abnormality is a well defined, ovoid mass in the posterior triangle of the left side of the neck; the mass is markedly hyperintense on the T2 and STIR series, and hypointense on the T1 series. There is a rim of T1 hyperintense fat surrounding most of the mass, representing displaced fat around it.

It shows avid heterogeneous enhancement on the post gadolinium series.

I note that the mass is high on the DWI series and also high on the ADC map, indicating shine through effect and facilitated diffusion.

These features are highly characteristic of a nerve sheath tumour, representing either a schwannoma or a neurofibroma.

I would flag this case for discussion at surgical MDT. The usual management is conservative, with a monitor and follow up approach.