3 year old girl presented with a painless swelling noticed below the right jaw line. It has been slowly increasing in size over the last 9 months. Ultrasound revealed a multiseptated cystic lesion in the floor of mouth. MRI was done for further evaluation.
MRI
Ax dwi
Ax ADC
Findings
- Fluid collection is seen epicentered in right sublingual space extending posteriorly beyond mylohyoid into the submandibular space and superiorly into right parapharyngeal space along the lateral margin of right tonsil.
- T2 hyperintense, T1 iso to hyperintense fluid with thin septae and facilitated diffusion. Minimal septal enhancement.
- No extension into other neck spaces.
Key points
- Cystic lesions with communication to sublingual space – always ranula has to be the first differential.
- In the absence of sublingual involvement, differentials to consider would include
- cystic hygroma
- branchial cleft cyst
- epidermoid
Read more
- Radiopaedia – ranula.
- Macdonald, Andre J., Karen L. Salzman, and H. Ric Harnsberger. “Giant ranula of the neck: differentiation from cystic hygroma.” American journal of neuroradiology 24.4 (2003): 757-761