History of sinus cancer. Status post chemo/RT 3 -- 09 CT of the soft tissues of the neck with infusion:Images through the skull base demonstrate a large destructive mass with intracranial extension at the level of cribriform plate and planum study done. There is elevation of bilateral frontal lobes (right greater than left) due to spread of tumor from the sinuses into the intracranial space. On this examination no definitive evidence of edema all brain parenchyma and in particular in the frontal lobes is detected. Spread of tumor intracranially is believed to be extradural. MRI examination is recommended to confirm this finding.Destructive mass involves bilateral ethmoid air cells (right greater than left) and the bilateral extension of tumor into the orbits bilaterally (right greater than left. There is no definitive involvement of cavernous sinuses. Tumor within the sphenoid sinus is also noted. Extensive bony destruction of the sinuses is noted. The mass extends inferiorly into the nasal cavity and bilateral maxillary sinuses. There is no definitive evidence of erosion of hard palate. However the mass appears to extend inferiorly to the hard palate. In comparison with the prior examination no definitive appreciable interval change is detected.Images through the soft tissues of the neck demonstrate no definitive adenopathy. New since prior examination is a mixed soft tissue and fluid density on the right which appears to surround the right thyroid cartilage. This is best appreciated on axial images 49 through 56 on coronal images. This finding is best appreciated on on images 48 through 52 there is however no definitive erosion of thyroid cartilage. The exact etiology of this finding is not clear and follow-up with an MRI is recommended.Images through the apices of the lungs demonstrate very large bilateral necrotic cavity forming masses which are new since prior study. Please review dedicated CT of chest performed the same date.CT of brain with infusion.Likely epidural intracranial spread of tumor in bilateral subfrontal region however no parenchymal edema is detected. This examination is otherwise unremarkable.80 cc of Omnipaque 350 was utilized for this study.
1.Large destructive mass at the skull base with involvement of bilateral ethmoid, nasal cavities, bilateral maxillary sinuses and sphenoid sinus as detailed. There is evidence of extension of tumor intracranially as well. This findings remains stable since prior study.2.No evidence of lymphadenopathy in the neck.3.New since prior examination is a soft tissue and fluid density lesion surrounding the right thyroid cartilage of unknown etiology. Correlate with history and follow up with an MRI is recommended.4.CT of brain demonstrates epidural intracranial spread of tumor in bilateral subfrontal region without edema of the brain parenchyma and with no evidence of leptomeningeal or parenchymal enhancement.