Dr. Ruchi Sharma
Radiodiagnosis
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I had a CT scan with contrast (upper abdomen, lungs, head, and neck) due to multiple enlarged right cervical lymph nodes. On biopsy, I was diagnosed with Kikuchi lymphadenitis. However, my left temporomandibular joint (TMJ) and masseter muscle are more bulging out compared to my right side. I do suffer from TMD due to crossbite since I was young. I spoke to my ear nose and throat (ENT) doctor, and he said that it is my masseter muscle being more define due to temporomandibular disorder (TMD) as the computed tomography (CT) scan does not pick up anything odd. I had this bulging feeling for more than eight years. However, I feel like there is a lump feeling there, not sure if my parotid gland is swollen or a swollen lymph node, but the doctor (ENT and radiologist) said the CT scan does not show any mass and told me not to worry. Can you re-evaluate my CT scan to see if there is any mass or lymphadenopathy on the left side of my face near the parotid gland and masseter muscle area? Please ignore the cervical lymphadenopathy.
Hi,
Welcome to icliniq.com. Based on the image you have uploaded (attachments removed to protect the patient's identity), there is no mass or inflammation in the left parotid region. Fat planes around the left parotid region's anatomical structures are well maintained, which again goes against any inflammation. Soft tissues in this region show no signs of inflammation either. Yes, I agree that the left masseter is more bulging as compared to the right side, which could be of course, due to temporomandibular disorder (TMD). I hope I have been able to answer your query. Take care and stay safe.
Patient's Query
Hi doctor,
Can you check the CT scan on my entire left cheek area from my ear to my lips (temporalis, parotid, masseter, lateral and medial pterygoid, mandible, buccinator, masseteric space, buccal space) for any mass or swollen lymph node because sometimes I do feel like there is a lymph node (around 1 to 2 cm) somewhere around that area? Also, can you check on my left cervical and supraclavicular area for any swollen lymph node, as I feel like there is a round swollen lymph node above my collarbone?
Hi,
Welcome back to icliniq.com. I went through the computed tomography (CT) images that you have provided. Yes, there are multiple cervical nodes, as mentioned. There is one in the left lower cervical region too. It is close to the left supraclavicular area. As you have mentioned that a biopsy diagnosis of Kikuchi disease has already been made. Therefore be assured that it is a benign disease of the lymph nodes in the neck and the treatment is generally supportive with NSAIDs (non-steroidal anti-inflammatory drug). Corticosteroids are recommended in the case of generalized Kikuchi disease. Do not be worried if 1 or 2 lymph nodes are not mentioned in the CT report, and you can feel them. Some swellings regress with treatment or may come up new since you got your last scan. Let this not make you anxious. I hope this answers your query. Take care.
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Radiodiagnosis
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