Imaging Guidelines for Masses in the Left Upper Back Near the Neck/Shoulder Junction

Key Components to Include in the Order

The American Academy of Otolaryngology-Head and Neck Surgery recommends specifying "evaluation of mass in left upper back near neck/shoulder junction" in the clinical indication for an MRI order 3, 4
The anatomical location should clearly state "left upper back/neck/shoulder junction" in the order 5
The American Academy of Otolaryngology-Head and Neck Surgery suggests requesting MRI with intravenous contrast unless contraindicated, as it significantly improves characterization of the mass and delineation of lesion borders 1, 2
Relevant clinical information to include in the order are duration of mass presence, size of mass, consistency, associated symptoms, and prior interventions or treatments 4, 6, 7

The American Academy of Otolaryngology-Head and Neck Surgery recommends always requesting contrast unless contraindicated, as it improves characterization of the mass, delineation of lesion borders, and identification of potential primary sites 1, 2
Contraindications to contrast include severe renal insufficiency and known contrast allergy 1, 2

Post-contrast T1-weighted sequences should be requested in the MRI order 1, 2
Imaging in multiple planes (axial, sagittal, coronal) should be requested in the order 2

The American College of Radiology recommends avoiding ordering CT with and without contrast as this doubles radiation exposure with minimal added benefit 1, 2
The American Academy of Otolaryngology-Head and Neck Surgery suggests not omitting contrast unless specifically contraindicated, as non-contrast studies provide significantly less diagnostic information 1, 2
Vague anatomical descriptions should be avoided as they may lead to incomplete imaging of the area of concern 5, 8
Relevant clinical history should be included in the order as it guides radiological interpretation 4, 6

If the patient cannot tolerate MRI, the American Academy of Otolaryngology-Head and Neck Surgery recommends considering specifying "CT neck with contrast" as an alternative 1, 2
For patients with suspected malignancy, the American Academy of Otolaryngology-Head and Neck Surgery suggests including information about risk factors or concerning features to help guide radiological interpretation 7, 4