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Image IQ: 16-Year-Old Presenting with Swelling Beneath the Tongue and Discomfort

  • Amar Udare, MBBS, MD

August 21, 2018
  • Image IQ
  • DI Executive

16-year-old presenting with swelling beneath the tongue and discomfort.

CT scan of the neck shows a fluid density well defined thin-walled lesion at the floor of the mouth in the sublingual and submandibular space.

What is your diagnosis?
A. Ranula
38% (114 votes)
B. Cystic hygroma
12% (36 votes)
C. Thyroglossal duct cyst
38% (115 votes)
D. Abscess
12% (35 votes)
Total votes: 300

Answer: A. Ranula

Discussion:

 

  • Benign retention cysts of the salivary glands seen at the floor of mouth[1].
  • “Rana” stands for frog in Latin as it often resembles frog’s underside on clinical examination [2].
  • Prevalence is 0.2 in 1000.
  • Occurs in children and young adults[2].
  • Most common site is the floor of mouth involving the sublingual gland and rarely the submandibular gland. Following morphologies have been described:

o Simple ranula: Cyst involves only the sublingual space[1].
o Plunging/ diving / cervical ranula: Extends into the submandibular space either along the posterior edge of myolohyoid muscle or through a deficiency in the muscle [1].

Imaging features:
 

Ultrasound:

  • These appear as thin walled anechoic lesions at the floor of the mouth.

CT and MR

  • Well defined unilocular water density (0-10HU) lesion at the floor of the mouth with smooth capsules and devoid of internal septations [2]. On MRI owing to the fluid nature of the contents these appear as high signal intensity on T2W and iso/hypointensity on T1W images[2].
  • Plunging ranulas are seen extending into the submandibular space and the communication between the sublingual and submandibular components can have an appearance of a “tail sign” with smooth tapering anteriorly into the sublingual space [2].
  • Infected cysts / recurrent cysts can have thick walls with heterogeneous contents[1].

Management:

Surgical resection is the treatment of choice.

References:
1. Gaillard, F. (2018). Ranula | Radiology Reference Article | Radiopaedia.org. [online] Radiopaedia.org. Available at: https://radiopaedia.org/articles/ranula [Accessed 12 Aug. 2018].
2. Kalra V, Mirza K, Malhotra A. Plunging Ranula. Journal of Radiology Case Reports. 2011;5(6):18-24. doi:10.3941/jrcr.v5i6.682.

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