Findings:
There is a well-encapsulated lobulated mass is seen in between the left trapezius and posterior scalene muscles is seen, measuring approximately 6.7 x 10.5 x 9 cm. It is of high signal intensity on both T1W, and T2WI, attenuated on suppressed fat sequence (STIR) with multiple thin fibrous septations within (<2 mm). No solid components. The left external jugular vein is displaced anteriorly.
Mildly asymmetrical enlargement of the palatine and lingual tonsil is seen. The palatine tonsils measure approximately 2.7 x 3 x 5 cm on the left and 2 x 3.3 x 5 cm on the right side. The para pharyngeal space is unremarkable.
Enlarged level I and II lymph nodes are seen bilaterally, for example 2 cm measuring left submandibular lymph node.
The parotid, submandibular and thyroid glands are normal.
The imaged brain parenchyma is unremarkable. The paranasal sinuses and the mastoid air cells are clear.
No bony abnormality is seen. The craniocervical junction and spinal canal appear patent.
Conclusion:
Large intramuscular lipoma of the neck on the left side, located in between the left trapezius and posterior scalene muscles.
Enlarged palatine and lingual tonsils as well as bilateral level I and II lymphadenopathy, DDX inflammatory in nature; DDX lymphoma. Clinical correlation and histological evaluation is advised.