49-year-old female with right neck mass. Per prior requisition, history of craniopharyngioma status post resection. Head CT: Stable postoperative changes are noted status post resection of craniopharyngioma with surgical clips in the sellar region. If clinical suspicion for the recurrence of craniopharyngioma is high, MRI may be considered. There is a well corticated focal bony deformity located along the inner table of the right parietal convexity. Similar findings were noted on the MRI from 2003 and have not changed since then. These findings likely represent an atypical arachnoid granulation with cortical vasculature extending through it. Recommend routine MRI with SPGR sequence for evaluation of this lesion if clinically indicated.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Neck CT: There is diffuse contrast enhancing lymphadenopathy in the neck bilaterally, right greater than left. The largest lymph node measures approximately 2.3 x 2.1 cm and located at the level 2 of the right jugulodigastric chain. No evidence of airway obstruction or midline shift. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. Mild degenerative changes are noted in the vertebral bodies of the cervical spine. Otherwise, the osseous structures are unremarkable.
Extensive bilateral, right greater than left, neck lymphadenopathy without a discrete primary lesion. Although an inflammatory process with reactive lymphadenopathy is possible, a neoplastic lesion cannot be excluded.