On the computed tomography (CT) scan, there was a well-defined bony protuberance just lateral to the left occipital condyle, in keeping with a paracondylar process. It extended inferiorly to articulate with a separate 1.4-cm osseous fragment, which in turn articulated with a protuberance from the left transverse process of the atlas (epitransverse process; Fig. 1 for diagrammatic representation). The findings corresponded to the clinically palpable lump with no other osseous or soft-tissue mass lesion identified.