Diagnosis: Personal history of malignant neoplasm of other and unspecified parts of oral cavity and pharynxClinical question: h/o HNC, please compare to previous measurements Brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Neck:The patient is status post left submandibular gland removal.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.The right jugular digastric node measures 11 x 8 mm axial dimensionsThere is a 7 x 9 mm axial dimension right retropharyngeal node of Rouviere present it previously measured 9 x 5 mm axial dimensions.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the right submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are degenerative changes in the cervical spine with endplate and uncovertebral osteophytes at C4-5 and C5-6 with only mild narrowing of the spinal canal .
1.Compared to the prior exam the patient's examination has not changed. There are number of lymph nodes in the right suprahyoid neck which are stable and compared to the previous exam and do not meet size criteria for adenopathy.2.There is no evidence for brain metastases or perineural spread..