 Images are limited by extensive patient motion and areas of incomplete fat saturation on post contrast imaging. There is asymmetric thickened and enhancing posterior hypopharyngeal soft tissue from the upper C3 to C3-C4 levels more prominent to the right of midline, at the approximate level of the anterior hyoid bone. This extends from to the pharyngeal mucosal surface, with grossly intact prevertebral musculature. This measures approximately 1.8 cm transverse by 1.0-cm AP by approximately 1.7 cm CC. There is slight mass effect upon the adjacent piriform sinus which remains aerated. Associated T2 hyperintensity is noted in this location. Preservation of the retropharyngeal fat plane is difficult to determine on this limited MRI, but there may be violation suggested on the sagittal post-contrast images.PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are otherwise unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. There is heterogeneous enhancement and T2 hyperintensity in the left lobe of thyroid gland which is mildly enlarged. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: The visualized intracranial structures are unremarkable. There is redemonstration of anteromedial right apical pulmonary opacity which is partially visualized, with similar configuration to that of the prior CT. There is mild-moderate mucosal thickening throughout the paranasal sinuses. There is focal opacity on the coronal images in the anterior right upper lobe consistent with an area of hypermetabolism on the prior PET CT. Evaluation for interval change in size is difficult due to differences in technique. Degenerative changes are again seen involving the cervical spine especially at C3-C4 and C4-C5, where there may be a posterior osteophyte disk complex with possible additional ossification of the posterior longitudinal ligament. There is flattening of the ventral cord and likely at least mild to moderate central spinal canal stenosis C3-C4. There may be moderate to moderate severe bilateral foraminal narrowing at these levels.
1. Severely limited exam due to extensive patient motion and areas of incomplete fat saturation. Abnormal signal and enhancement within the right paracentral and midline posterior hypopharyngeal soft tissues extending to the mucosal surface at the C3 to C3-C4 level. This correlates with previous area of increased uptake on PET CT, but does not appear to involve the prevertebral space, as normal musculature is visualized. This could relate to an additional primary neoplasm or inflammatory process. A follow-up contrast-enhanced CT of the neck may be helpful to evaluate for retropharyngeal involvement, and correlation with direct inspection is recommended given apparent involvement of the mucosal surface.2. Heterogeneous enhancement and abnormal signal in the left lobe of the thyroid gland which is enlarged. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.3. Partially visualized cervical spondylotic changes which may be further evaluated with dedicated MRI of the cervical spine if clinically indicated.4. Partially visualized pulmonary findings previously seen on PET/CT system patient's known malignancy, with direct comparison difficult due to differences in technique.