History of laryngeal cancer. Receiving chemotherapy. CT of the soft tissues of the neck:Images through the skull base and including cavernous sinuses remain within normal limits.Images through the larynx reidentifies post therapy changes and with no definitive evidence of residual tumor. It has not changed in appearance since 2/25/07. The thyroid cartilage shadow remains splayed. The glottis is not distorted. The epiglottis is not identified No evidence of pathologic adenopathy in the neck. There is a left jugular chain lymph node present at the level of the hyoid bone measuring about 8 mm short axis dimension which can be identified on previous exams dating back to 22507 when it measured 6 mm short axis dimension. Limited images through the apices of the lungs and mediastinum are negative for metastatic lesions. Large quantities of air within the esophagus may reflect reflux. This finding was noted on prior study and no change. There are atherosclerotic calcifications of the carotid bifurcations on the left side the there is concern for significant narrowing of the left internal carotid artery at its origin.There are degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at multiple levels and associated narrowing of the spinal canal and the neural foramina in the upper cervical spine there is some right-sided facet hypertrophy.The patient is status post median sternotomy.The esophagus appears to have diverticulum at the level of the thoracic inlet which is directed anteriorlyCT of brain with infusion.There is a focus of encephalomalacia in the left cerebellar hemisphere unchanged since prior exams which likely represents a prior infarct. Periventricular and subcortical white matter hypodensities are present which are nonspecific but likely vascular related at this age.. A hypodense focus is redemonstrated at the genu of the right internal capsule probably lacunar infarct. There is associated atrophy of the right caudate nucleus.Along the left parietal lobe adjacent to the left intraparietal sulcus there is a small focus of enhancement measuring approximately 6 mm in size. This was not present on prior exams and is suspicious for metastatic disease. If clinically appropriate an MRI of the brain may help confirm this and to help identify additional foci that may be present. It is best seen on image number 22 and 21 of the axial CTs of the head
1.Stable CT of soft tissues of the neck and with no evidence of tumor or pathologic adenopathy.2.Suspicion for left parietal lobe metastasis as described above. This is new since the prior exam. An MRI of the brain may help confirm this and identify any other lesions. referring clinician was paged.3.Findings raise the question of a left carotid stenosis please correlate with clinical evaluation and at any other evaluation of the carotids.4.Findings suggest an esophageal diverticulum unchanged since prior exams.5.Findings suggest old infarctions previously demonstrated as described above.