64-year-old male with history of nasopharyngeal cancer presents with increasing fatigue, right ear effusion and ulcer noted in the nasopharynx Beam hardening artifact from dental hardware limits evaluation of oral cavity.There is intense enhancement and swelling of the mucosa of posterior nasopharynx. A nonenhancing ulceration is seen in the posterior-superior nasopharynx with debris and air bubbles seen within the ulcer crater. There is subtle cortical erosion along the anterior clivus immediately posterior to the ulceration which appears more prominent and conspicuous on this exam as compared to the previous exam. These findings may represent infection, tumor, or be related to post radiation changes. MRI with contrast is recommended for further characterization.There is no evidence of exophytic mass. The right submandibular gland appears slightly enlarged in comparison to the left; however no discrete mass is identified. The parotid and thyroid glands are unremarkable.Atherosclerotic calcifications are again seen at the common carotid artery bifurcation bilaterally and at the origins of the great vessels arising from the aortic arch. Stable postsurgical changes are seen in the right neck. No pathologically enlarged cervical lymph nodes are identified.There is mild mucosal thickening involving the left ethmoid and sphenoid sinuses. Additionally, there is partial opacification of the right mastoid air cells without bone erosions or destruction. The right middle ear cavity also appears opacified without evidence of bony destruction.Vertebral body heights are maintained without evidence of acute fracture. Mild degenerative changes affect the cervical spine. See accompanying CT scan of the chest for additional information.
1. Ulceration is seen in the posterior-superior nasopharynx with associated subtle cortical erosion of the anterior clivus which appears mildly progressed as compared to the prior exams. These findings may represent infection, tumor or be related to post-radiation change. MRI with contrast is recommended for further characterization.2. New partial opacification of the right mastoid air cells and right middle ear cavity without bony destruction, raising the question of post obstructive otitis. 