Clinical question: History of buccal mucosal cancer. Status post chemo. Evaluate for response. Signs and symptoms: None Enhanced CT of soft tissues of neck:This examination is severely limited due to patient's cervical fusion (fixating rods and multi-level transpedicular screws), significant kyphosis and extensive metallic dental filling. Extensive areas of the study is completely obscured by streak artifact from the metal and poor quality exam due to inability of patient to lie flat within the scanner.Within the significant restriction no definitive evidence of any new masses or pathologic adenopathy is noted. Very extensive postoperative changes of neck is again noted. Examination again demonstrates very heavy calcification of bilateral carotid bifurcations. Significant artifacts obscures the detail for assessment of vascular stenosis. Grade 1 anterolisthesis of C3 on C4 and and minimal retrolisthesis of C5 on C6 is again identified.Enhanced MRI of brain:There is no evidence of abnormal enhancement of brain parenchymal or leptomeninges. Findings suggestive of advanced small vessel disease of indeterminate age are again identified.Calvarium is intact.Complete opacification of left mastoid air cells and partially of the left middle ear cavity with no detectable bony changes is again identified. Limited view of paranasal sinuses are unremarkable. Right mastoid air cells and middle ear cavity are unremarkable.70 cc of Omnipaque 350 was administered per above studies.
1.Severely limited CT examination of soft tissues of neck due to above described causes. Examination however grossly remains similar to prior study and with no evidence of tumor or pathologic adenopathy.2.Negative CT of brain and calvarium for metastatic disease. Extensive small muscle disease of indeterminate age.