Findings:
A well defined ovoid encapsulated lesion appearing heterogeneously T2, STIR hyperintense and T1 hypointense in the right post-styloid parapharyngeal space, medial to the carotid space. The lesion measures 3.2 x 1.8 x 2.0 cm (CC x AP x ML), over C2 level. No evidence of flow voids within the lesion. The lesion is longitudinally oriented without neural foraminal extension. There is no arterial phase enhancement. In the delayed phase, the lesion shows homogeneous enhancement. There is no frank evidence of local invasion.
The lesion displaces the internal carotid artery laterally without separating nor encasing the vessels.
The lesion is anterior to the ipsilateral longus capitus and longus coli muscles.
A well defined intensely enhancing lesion is seen in the right side of neck near bifurcation of right CCA with intense enhancement in the arterial phase, measuring approximately 2.8 x 2.1 x 1.8 cm (CC x AP x ML). The lesion does not splay the internal and external carotid arteries.
Another Similar signal enhancing lesion is noted in the left carotid triangle near left CCA bifurcation approximately 1.2 cm and mildly splaying the left internal and external carotid arteries.
A few mildly enlarged bilateral sub lingual lymph nodes are seen, measuring up to 1.9 cm in the short axis.
The parotid, submandibular and thyroid glands are normal.
The pharyngeal and glottic regions are normal. The tonsils and adenoids are normal.
A tiny cystic lesion is seen in the glossoepiglottic fold (SE 4, IM 24) without airway obstruction.
The imaged brain is unremarkable.
There is an encapsulated cystic lesion associated with an unerupted right upper third molar – likely representing inspissated dentigerous cysts. The paranasal sinuses and the mastoid air cells are otherwise clear.
No bony abnormality is seen. The craniocervical junction and spinal canal appear patent.
Conclusion:
Appearances are likely in keeping with bilateral carotid body paraganglioma and right-sided schwannoma of cervical sympathetic chain in the right parapharyngeal space, DDX glomus vagale paraganglioma. Further surveillance is advised.
Inspissated, likely dentigerous cyst in the right maxillary sinus associated with an unerupted tooth.