Dysphagia. Neck lump. PET/CT scan showed soft tissue mass posterior to the trachea, potentially from the known thyroid cancer. The patient has rising globulin. He received RAI 55 years ago. History of papillary thyroid cancer; status post total thyroidectomy and right modified radical neck dissection on December 19, 2014. He had two positive lymph nodes in the central neck and 0/24 nodes in the right lateral neck. He also had invasion of the middle thyroid vein on the right, and minimal extrathyroidal extension into the strap muscles on the right. Subsequently, he underwent radioactive iodide treatments but was told that he had persistence and recent thyroglobulin levels have increased. There are changes of previous thyroidectomy. There is a rightward-eccentric, infiltrative, mildly STIR-hyperintense mass located just inferior to the posterior part of the cricoid cartilage. It demonstrates diffusion restriction diffuse contrast enhancement. The mass posteriorly displaces the uppermost esophagus with no intervening fat plane. It also displaces the trachea anteriorly with high likelihood of invasion into the trachealis muscle and the right posterolateral aspect of the first tracheal ring. It causes mild tracheal narrowing. Craniocaudally, it measures 2.5 cm and abuts the posterior arch of the cricoid cartilage without grossly eroding into it. It wraps around 50% of the circumference of the upper-most trachea and measures axially 4.3 cm x 3.0 cm. Focally decreased T1 signal within the right side of the mass probably reflects susceptibility artifact. Previous PET CT showed a surgical clip in a similar location. The larynx is unremarkable without definite invasion into the cricoid or thyroid cartilages. There is also no definite invasion into the adjacent vertebral bodies of C7 and T1. There is also no vascular encasement and major neck vessels are patent.There is no discrete cervical lymph node enlargement. The major salivary glands are unremarkable.There is complete opacification of the right maxillary sinus with inspissated secretions. There is partial opacification of the ethmoid and left maxillary sinuses and fluid in the right sphenoid sinus. Both orbital lenses have been replaced.Included lung apices are notable for posterior apical pleural thickening was present on the previous PET/CT.
1.Soft tissue mass involving the upper-most part of the tracheoesophageal groove with signs of invasion into the upper-most trachea, likely representing either a local recurrence given proximity to surgical clips, or regional lymph node metastasis related to the known thyroid cancer.2.There is no separate cervical lymphadenopathy.3.Opacification of the paranasal sinuses including complete opacification of the right maxillary sinus and fluid in the right sphenoid sinus may reflect sinusitis in the proper clinical setting.