54 years old patient with a newly diagnosed larynx cancer. CT scan of the head and neck requested to evaluate the extent of the cancer and to rule out brain metastases. Neck CT:At the supraglottic level of the larynx, we note a complete obliteration of the epiglottic fat by an enhanced mass, which extends from the vocal cords inferiorly to the superior tip of the epiglottis superiorly. There is involvement of the aryepiglottic folds, resulting in effacement of the piriform sinuses. There is effacement of the bilateral valleculae, and likely involvement of the most inferior aspect of the tongue base. The lesion measures 45-mm as largest cranio-caudal diameter and 21 x 34 mm axially . The lesion is homogeneously enhanced with a central focal low attenuation probably related to focal necrosis.Inferiorly, at the glottic level, we note thickening of the vocal cords, probably related to infiltration of the mass, but without any evidence of subluxation or complete invasion of the arytenoid or cricoid cartilage.The thyroid cartilage appears heterogeneous with mild scalloping on the surface abutting the mass; although this may represent variant of cartilage ossification, focal infiltration of the cartilage near the anterior commissure is suspected. A gadolinium injected MRI of the neck can be considered for better definition of cartilage invasion.Presence of 3 to 4 small lymph nodes measuring less than 1 cm in short axis diameter are considered nonpathological based on CT criteria (level II and III). There is a slightly bigger 12-mm diameter lymph node located on the left side at the level 3 and level 4 junction.Presence of a 8mm diamter lymphatic node in the superior mediastinum is nonspecific.No obvious noduel is seen in the lung apices. Please correlate with chest CT scan.Study of the bone structure shows degenerative disease of the spine related to the age of the patient.Head CT:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.No enhancing intracranial abnormalities are seen.
1. Presence of a large laryngeal supraglottic mass occupying and obliterating completely the preepiglottic space, infiltrating inferiorly to the vocal cords and extended superiorly to the level of the hyoid cartilage as described above.2. Probable invasion of the anterior aspect of the thyroid cartilage. Better evaluation of the cartilage invasion can be obtained by an enhanced MRI of the neck.3. Presence of a slightly enlarged lymph node at left level 3 and 4 junction. Multiple other small lymph nodes are still within normal limits based on CT criteria.4. Negative brain CT scan.Electronically Signed: 7/7/2010 9:48 AM Raghid Kikano, MD