55-year-old female with mandible infection, c/w CT images from 4/2015, history of recurrent tongue cancer. Per chart, history of recurrent oral tongue cancer status post right partial glossectomy and modified radical neck dissection in October 2009 followed by adjuvant chemoradiation. Recurrence in May 2013 status post chemotherapy completed in June 2013, with a recurrence status post right hemiglossectomy and left forearm free flap reconstruction in August 2013. Status post chemotherapy and re-irradiation for third recurrence into the root of the tongue extending submucosally into the left base of the tongue extending up the left pharyngeal wall and the left posterolateral tongue. Completed Abraxane and chemoradiation in November 2014, base of tongue biopsy 1/14/15 negative for recurrence. Metal artifact from the patient's surgical hardware related to prior mandibulotomy limits adequate evaluation of the surrounding structures. The mandible cannot be fully assessed especially in the areas of prior infection due to metal artifact. Patient is also status post right hemiglossectomy and neck dissection with flap reconstruction. Using the hyoid bone as a landmark, when compared with prior CT study the previously noted areas of hypodensity along the posterior aspect of the left tongue base demonstrate heterogeneous diffuse enhancement on the current study, which are somewhat nonspecific and limited by metal artifact. However, there is no focal mass lesion identified and enhancing tissue is confluent with adjacent soft tissues. There is increased thickening of the adjacent mucosal surfaces which may reflect post treatment changes. There are scattered prominent mediastinal lymph nodes which are not pathologic by size criteria and were noted on the previous CT. The diffusion weighted images are essentially nondiagnostic due to metal artifact.Within the visceral space the thyroid gland appears within normal limits.The airway appears patent.There is trace fluid in the mastoid air cells bilaterally. There is asymmetric pneumatization of the left petrous apex now containing a small amount of fluid.The parotid and the submandibular glands appear unremarkable.Patient is status post tracheostomy.When correlating with prior CT, there are confluent areas of mineralization posterior to the vertebral bodies of C4-C6 compatible with ossification of the posterior longitudinal ligament. There is associated up to moderate spinal canal stenosis most prominent at C5/C6 with deformity of the spinal cord at this level. There is bilateral moderate-severe foraminal stenosis at C5/6.
1.There is no definite focal mass lesion. However when compared to prior CT, the previously noted areas of hypodensity along the posterior margin of the left tongue base now demonstrate diffuse heterogeneous enhancement which is nonspecific and may represent posttreatment changes. Correlation with PET study is recommended to exclude tumor recurrence.2.No cervical lymphadenopathy. Stable scattered prominent mediastinal lymph nodes.3.Ossification of the posterior longitudinal ligament with associated moderate spinal canal stenosis most prominent at C5/C6 with deformity of the spinal cord at this level. There is bilateral moderate-severe foraminal stenosis at C5/6. 