Reason: any change in plexiform of left side of neck and face History: facial weakness, plexiform tumor of the left side of neck and face and axilla. Reason: Status post plexiform neurofibroma decompression, 9 month follow up after surgery for surveillance /changes History: follow up after surgery for NF tumor There is redemonstration of an extensive STIR hyperintense enhancing infiltrative mass centered in the right pterygopalatine fossa with extension into multiple skull base foramina as previously detailed, including significant expansion of the right cavernous sinus. There is medial extension into the right nasal cavity with minimal extension into the right inferior orbit via the inferior orbital fissure. There is also extension inferolaterally into the right lower facial subcutaneous fat. The mass now measures up to 7.4 cm oblique on coronal imaging 1201/20, compared to previous 7.2 cm.In addition, there is an additional larger transspatial STIR hyperintense enhancing mass in the left posterior lateral neck, along the posterior triangle. This mass is more fully included within the field-of-view on the current exam, measuring approximately 11.4 cm in area of greatest confluence (1201/44), where as it previously measured at least 10 cm.Postoperative changes of left-sided thoracotomy are also noted related to debulking of previously seen extensive left chest wall plexiform neurofibroma with involvement of the left supraclavicular fossa and left axilla. There also postoperative changes from C5 to L1 laminotomy for lower cervical tumor resection. Significant kyphosis is again seen cervical thoracic junction, similar to prior exam with grade 1 anterolisthesis of C6 on C7, C7 on T1 as well as retrolisthesis of T1 on T2. Overall, there is up to moderate central spinal canal stenosis at C7-T1 with slight flattening of the right ventral cord.Tumor again extends into multiple left-sided foramina, including down to at least the T1-T2 in a confluent fashion, with a smaller mass at left T2-T3 and additional prominent left foraminal components on the left at T3-T4 and T4-T5. The left T4-T5 lesion results in the most mass effect upon the thecal sac although overall there is no significant stenosis. There is also no abnormal cord signal. There remains a stable prominent lesion along the right T7-T8 foramen without extension into the spinal canal. There is opacification of left ethmoid air cells. There is decreased fluid within right mastoid air cells/middle ear. There is moderate mucosal thickening within the left maxillary sinus with mild mucosal thickening in the smaller right maxillary sinus. A tiny linear T2 hyperintense lesion is again seen along the left upper lip. There is also partially visualized infiltrative mass extending into the left upper extremity down at least to the level of the elbow. There are multiple scattered enhancing STIR hyperintense lesions in the posterior intercostal spaces at multiple levels, which may represent additional nerve sheath tumors. Mild dependent atelectasis is suggested. There is redemonstration of the mass extending into the mediastinum on the left side.
1. Overall, no significant interval change in extensive plexiform neurofibroma with right-sided facial/skull base component centered in the right pterygopalatine fossa.2. Improved visualization of overall extensive left transfacial plexiform neurofibroma centered in the left lower neck and left upper chest, with multilevel left foraminal components without evidence of cord compression. The most medialized exophytic component of the mass is located at the T4-T5 level.3. Stable prominent kyphotic deformity at the cervical thoracic junction, with mild grade 1 subluxations. 4. Continued mild-moderate central spinal canal stenosis at C7-T1 with mild flattening of the right ventral cord.