Thyroid cancer. Head CT:Nonspecific cerebral white matter hypoattenuation is compatible with small vessel ischemic changes. There is no evidence of intracranial mass, hemorrhage or infarction. No enhancing abnormality is seen. Neck CT:There is a large, irregular, heterogeneous mass at the thyroid bed, measuring 44 x 34-cm (series 4, image 56). There is likely involvement of the bilateral sternocleidomastoid muscles. The mass invades the trachea and extends to the right tracheo-esophageal groove, likely also involving the esophagus. There are satellite lesions in the right sternocleidomastoid muscle.A necrotic nodule measuring 13 x 16-mm (image 52, series 4) is seen, consistent with right level 6 adenopathy. There is extracapsular extension, and partial encasement of the right carotid artery.There is prominent soft tissues thickening along the tectorial membrane at C1 and C2 levels of uncertain etiology. Nonspecific lucent lesions are seen in C2 vertebra. MRI of cervical spine is recommended to exclude neoplasm. Degenerative disease of the cervical spine is seen, with disk osteophyte complex at C4 - C5 level, causing spinal canal stenosis. Severe neural foramina narrowing is also seen at multiple levels.
1. Large, necrotic mass in thyroid bed, with involvement of bilateral sternocleidomastoid muscles, and invasion of the trachea. There is also likely involvement of the esophagus.2. Right level 6 adenopathy with extracapsular extension and partial encasement of right carotid artery.3. Nonspecific vague lucent lesions in C2 vertebra, with soft tissue thickening along tectorial membrane. Correlation with MRI is recommended.4. Degenerative disease of cervical spine, resulting in spinal canal stenosis and foraminal stenosis..