Evaluate hyperintensity seen on MR neck. T1N2b right hypopharyngeal SCC diagnosed in 2/2013 s/p radical right neck dissection and adjuvant cis/RT from 5/2013-7/2013. Right posterior neck recurrence in 9/2013 s/p right posterior neck dissection was performed in 12/2013 c/w well differentiated SCC, with second skin recurrence in right supraclavicular region s/p neck dissection with positive margins on 4/22/2014. Neck: There are postoperative findings related to right neck dissection with no significant change in diffuse enhancement in the right lower neck subcutaneous tissues and paraspinal muscles. Likewise, there is mild ill-defined diffuse hypopharyngeal swelling and enhancement. These findings are most likely treatment related. There is no discrete measurable mass lesion or significant lymphadenopathy in the neck. Please refer to separate CT report for findings in the chest.The thyroid and major salivary glands appear unchanged. The right internal jugular vein appears to have been scarified. The other major cervical flow voids appear to be grossly intact, with a left sided central venous catheter in position. The osseous structures are unchanged with T1 hypointensity involving the inferior C5 vertebral body on the right unchanged and likely on a degenerative basis. There is minimal mucosal thickening involving the paranasal sinuses. Tiny left maxillary mucous retention cyst. Mastoid air cells are clear.Brain: No intracranial mass or mass-effect. There is mild diffuse enhancement of the dura along the left frontoparietal convexity. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with advanced chronic small vessel ischemic disease. Major flow-voids are preserved. There is global parenchymal volume loss. Sella and orbits are grossly within normal limits. Diffuse T1 shortening involving the bone marrow compatible with prior radiation treatment.
1. No significant change in diffuse enhancement in the right lower neck subcutaneous tissues and paraspinal muscles, which is likely related to prior surgery and radiation treatment. No discrete mass or significant lymphadenopathy in the neck to suggest disease recurrence. 2. T2/flair hyperintensity in the bilateral periventricular and subcortical white matter is nonspecific but most consistent with moderate chronic small vessel ischemic disease.3. Mild smooth thickening and enhancement of the left frontoparietal dura which is nonspecific and may be related to prior surgery, radiation to the area, or possibly remote prior subdural hematoma, for example. Unlikely to represent neoplastic etiology.