Tonsillar Mass-MRI

40 yr old male  smoker  with hx of right tonsillectomy 10 months  for a tonsilar mass(HPE non- neoplastic), has recurrence in left tonsilar region wtih mixed signals and mass effect  suggesting possible inflammatory pseudo tumour, with differential of lymphoproliferative aetiologies .

Smoking as Trigger in the present case  for tissue aggression  is matter of debate.

Teaching points by Dr MGK Murthy

MRI Tech: Mr Satish

1. Tonsilar masses are rare and usually are of infectious nature with abscess / sequelae

2. Pathogenesis  possibly,  is exaggerated response to tissue aggression of unknown aetiology.  Differentials  on histology  like lymphoproliferative  causes/ spindle cell sarcomas may need immunohistochemistry

3.  The term Inflammatory pseudo tumour  , though primarily used in ref to retro orbital  location, can be found in tonsilar / laryngo tracheal/ middle ear/ salivary/ ganglion/ pterygo maxillary/ para pharyngeal  regions as well 

4.Labdata may show signs of infection including neutrophilia / raised ESR etc,but not necessary .

5. Cross sectional imaging may show tonsilar enlargement or grossly nodular thickening of  nasopahrynx/ supra glottis with cervical lymphadenopathy. Radiology has no definite characteristics to exclude  other aetiologies , though presence of necrosis/ tissues oedema/ enhancement on contrast may help. 

6. If antibiotics and steroids  do not resolve , surgical excision would   resolve the aetiology