Clinical question : History of lung cancer, base of toque cancer, status post CRT. Evaluate for disease, compared with prior. Signs and symptoms: As above. Enhanced CT of soft tissues of neck: 80 cc of Omnipaque 350 is administered for this exam.Images through the skull base and including cavernous sinuses are unremarkable with the exception of extensive vascular calcification of cavernous carotid.Images through the neck demonstrate very extensive post therapy/surgical changes of the neck and including a large anterior flap. There is however no detectable tumor or any pathologic adenopathy neck.Limited images through the apices of the lungs demonstrate complete opacification of right upper lung field similar to what was noted on prior exam. Pleural effusion bilaterally is also noted (left greater than right). This is a new finding since prior exam. Please review dedicated report of CT of the chest performed the same date which he upper lung fields with better advantage.Enhanced head CT:Examination demonstrates extensive findings suspect for a mass to small vessel disease of indeterminate age. There is a small focal area of low cortical enhancement in the right frontal lobe (axial image 15 and coronal reformatted image 48). This finding was present on prior exam however it appears more prominent on the current study. Recommend further follow with an MRI exam to exclude the possibility of metastatic disease. The finding could represent a small enhancing cortical stroke as well. This examination is otherwise unremarkable and there are no additional foci of abnormal enhancement brain parenchyma or leptomeninges.
1.No evidence of recurrence of disease in neck and the stable exam since prior study.2.CT examination of brain demonstrates small focus of cortical enhancement in the right frontal lobe (axial image 15 & coronal reformatted image 48). This finding was present on prior study however appears slightly more pronounced on the current study and recommend further follow-up with an MRI to exclude metastatic disease.