New dx nasopharyngeal ca, needs baseline neck imaging. There is an infiltrative somewhat lobulated enhancing nasopharyngeal soft tissue mass eccentric to the left corresponding to the region of hypermetabolic activity seen on recent PET/CT. The lesion is difficult to measure, however the right and central cranial aspect of the lesion measures approximately 1.9 x 1.4 cm whereas eccentric left aspect more inferiorly measures 1.3 x 2.2 cm. The mass is inseparable from the underlying adenoids.Multiple significantly enlarged bilateral neck lymph nodes are demonstrated corresponding to areas of increased PET activity. There is a large conglomerate of lymph nodes in the right level 2 nodal region measuring 5.5 x 5.4 x 5.7 cm (AP by transverse by CC). The right internal jugular vein is not visualized adjacent to this nodal mass and may be compressed or completely encased. A left level IIA partially necrotic node measures 3.7 x 1.8 x 3.8 cm. There is a left node of Rouviere measuring 2.1 cm. There is also an enlarged left level III/IV node. A few small supraclavicular lymph nodes are seen bilaterally.There is fluid present in the mastoid air cells. The visualized submandibular glands and thyroid gland appear grossly unremarkable. Developmental narrowing of the spinal canal with mild superimposed degenerative changes is seen.
1. Large infiltrative nasopharyngeal mass with right much greater than left cervical lymphadenopathy. 2. The right internal jugular vein is not identified amongst the level 2 nodal conglomerate.