74 year-old female with recurrent laryngeal cancer. Status post laryngectomy. Rule out recurrence and lung metastases. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and petrous bones remain negative for malignancy. Small retention cyst within the left maxillary sinus is again identified with no interval change.Images through the neck demonstrate post therapy/surgical changes. No evidence of a mass or pathologic adenopathy is present. Tracheostomy is noted. Small foci of nonenhancing tissue within the right lobe of thyroid matter present assist and remains stable since prior exam. This lesion measures approximately 4 mm in transaxial dimension. No detectable left lobe of thyroid.Limited images of mediastinum are negative for adenopathy.Limited images of the apices of the lungs are negative for metastatic lesions minimal apical scarring is noted. Please review the dictated report of CT of chest.No evidence of osseous or cartilaginous erosion. Complete laryngectomy is noted.CT of brain with infusion:No evidence of metastatic lesion to the brain, leptomeninges or the calvarium is detected. Findings of possible minimal small vessel disease of indeterminate age is again identified.Significant increased vascularity at the level of the tentorium and across the left cerebellum is highly concerning for an arteriovenous malformation/dural AVF. This finding was present on multiple prior studies and without any significant interval change. Further evaluation with a CT A4 MRA -- MRI is recommended.60 cc of Omnipaque 350 was utilized for the above studies.
1.No evidence of recurrence of disease in neck.2.No evidence of metastatic disease to the brain, leptomeninges or the calvarium.3.Arteriovenous malformation or an AVF in the left cerebellum needs further follow-up with dedicated studies of MRI / MRA or CTA examination or conventional angiogram.