Parotid malignancy, C-spine lesion. There is a destructive osseous lesion at C2 involving the inferior aspect of the the dens with cortical erosion anteriorly and mild prevertebral soft tissue extension. There is also mild erosion involving the posterior cortex on the right without significant epidural extension. The lesion measures 19 x 22 x 20 mm in the AP, transverse, and craniocaudal dimensions. There is minimal extension into the right C2-C3 neural foramen. The right vertebral artery courses along the lateral aspect of the lesion without evidence of encasement.There is also an enhancing lesion measuring 12 x 9 mm, AP x transverse dimensions, along the right aspect of the C2 spinous process with primarily soft tissue involvement and mild osseous erosion. There is also a 4 mm enhancing focus involving the superior aspect of the C3 vertebral body which is more nonspecific but may represent an additional tiny metastasis.No additional lesions are appreciated within the limits of motion degradation. Vertebral body heights are maintained. Cervical cord is normal in signal and contour. There is straightening of the cervical spinal curvature and minimal retrolisthesis of C5 on C6. Alignment is otherwise maintained. There are mild degenerative changes including disc osteophyte complexes at the C5-C6 and C6-C7 levels with partial effacement of the ventral thecal sac. There is no significant spinal canal stenosis at any level. There is mild right C2-C3 neural foraminal stenosis related to combination of tumor and facet arthropathy. There is also mild right C5-C6 neural foraminal stenosis related to uncovertebral hypertrophy.Large left parotid mass is partially imaged and better assessed on recent MRI neck study dated 11/4/2016. Cerebellar tonsils are borderline low.
1. Two enhancing lesions at the C2 level centered on the inferior aspect of the dens as well as the right lateral margin of the C2 spinous process consistent with metastases. There is additional tiny focus of enhancement involving the superior aspect of the C3 vertebral body which is more nonspecific but suspicious for an additional metastatic lesion.2. No evidence of epidural tumor or spinal canal stenosis at any level.3. Mild right C2-C3 and mild right C5-C6 neural foraminal stenosis.4. Large left parotid mass is partially imaged and better assessed on recent MRI neck study dated 11/4/2016.