Malignant neoplasm of parotid gland infiltrating surrounding structures seen on recent CT scan with right facial droop. Neck: There is a bulky, infiltrative, and partly necrotic right neck mass that involves the right parotid gland with extension into the right stylomastoid foramen, and involvement of the adjacent sternocleidomastoid muscle, parapharyngeal space, retropharyngeal space, paravertebral tissues, and right visceral space. The tumor measures up to approximately 13.5 cm. There is also surrounding extensive right cervical and retropharyngeal lymphadenopathy. There is also partially imaged mediastinal lymphadenopathy. There is diffuse swelling of the subcutaneous tissues and skin thickening in the right neck. The right internal carotid and right artery is encased by tumor, but does not appear to be significantly narrowed. Tumor also appears to extend into the right C2 transverse foramen, where it may contact the vertebral artery, without narrowing the vessel. There are bilateral hypoattenuating thyroid nodules. The osseous structures are unremarkable. There are multiple nodules in the imaged portions of the lungs. Brain: There is mild nonspecific patchy cerebral white matter T2 hyperintensity, but no evidence of acute infarction. There is no evidence of intracranial tumor. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.
1. Interval increase in size of a large infiltrative malignant right neck mass, with compromise of the right facial nerve and associated extensive right neck lymphadenopathy. In addition, the right internal carotid artery is encased by tumor, but does not appear to be significantly narrowed. Swelling of the overlying subcutaneous tissues may be related to lymphedema.2. No evidence of intracranial tumor or acute infarction.3. Nonspecific thyroid nodules. Thyroid ultrasonography may be useful for further evaluation.4. Nodules in the lungs may represent metastases. A dedicated chest CT or whole body PET may be useful for further evaluation.