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  • Presented for swelling under jaw.
  • Previously aspirated and suspected to be a salivary mucocele.
  • Progressive dyspnea, difficulty swallowing and change in bark recently.
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  • Large, irregularly shaped, fluid filled cystic area ventral to the cranial cervical spine.
  • Relatively high signal intensity on T2/STIR. Septae within the mass are T2 low signal.
  • Apparently portions of it contrast enhance (or contrast leaking into it) on MR, but not on CT.
  • Possible non-contrasting mass on the right side inside the cystic region (muscle belly most likely, clot or tumor less likely).
  • Lysis of the ventral aspect of C1.
  • Ventral and rightward deviation of trachea and esophagus (which is also compressed), ventral displacement of the soft palate.
  • Connection between ventral C1 and the fluid filled mass.
  • Mass appears to enter or communicate with the epidural space at C1/C2 and extends rostrally along the ventral aspect of spinal canal to the level of the foramen magnum.
  • Moderate synovial fluid accumulation and bulging of joint capsule around the dorsal articular facets of AO joint and C1 – C2.
  • Neoplasia
    • Primary tumor of C1.
    • Some sort of soft tissue neoplasia.
  • Acquired
    • Mengiocele.
    • Synovitis of some type with overproduction of synovial fluid.
    • Pharyngeal cyst with secondary necrosis and lysis of C1.
    • Chronic migrating foreign body with cyst/abscess.
  • Trauma
    • Previous trauma to C1/C2 resulting in CSF or synovial fluid leakage.
  • Synovial Myxosarcoma (low grade).
  • Surgically debulked then had radiation therapy. Did well following surgery.