64-year-old male with recurrent maxillary sinus cancer. Patient receiving cycle number two of 7 chemo/RT. Please perform CT neck soft tissue with contrast for staging purposes. The confluent metastatic lymphadenopathy in the left neck now measures 4.8 x 2.7 cm compared to 5.4 x 3.6 cm on study dated 7/14/2008. The central region of this lymphadenopathy is now more hypoattenuating with continued peripheral enhancement. This consistent with necrosis. The multiple submandibular lymph nodes (previously seen on series 3 image 50 on study dated 7/14/2008) remain visible but now have hypoattenuating centers consistent with necrosis. The tumor mass approaches the left side of the thyroid cartilage but does not appear to invade the cartilage. A left supraclavicular lymph node (series 9557 image 68) now measures 1.9 by 1.8 cm. on the prior study this measured 2.1 x 2.0 cm. There is a right cervical lymph node which measures 1.1 x 1.0 cm compared to 1.0 x 0.9 cm on the prior study.Patient is status post partial left maxillary resection. There are postsurgical changes involving the pterygopalatine fossa. There are no CT findings of local tumor recurrence, however, MRI is more sensitive for distinguishing postoperative changes from local tumor recurrence. The there are surgical clips in the left neck and the left internal and external jugular veins are absent consistent with prior neck dissection. There is left -sided skin thickening consistent with prior radiation.The left mastoid air cells are filled with fluid. The left middle ear is filled with fluid consistent with postoperative otitis. The styloid processes are prominent bilaterally. There are degenerative changes most pronounced in the cervical spine. There are no definite bony metastases.The visualized portion of the brain is unremarkable on this limited study. There are no findings of metastasis or intracranial extension of tumor.There are paraseptal and centrilobular emphysematous changes in the lungs with bilateral apical scarring. The ascending aorta is borderline dilated with a diameter of 4.2 cm. There is a right-sided chest port with a catheter which enters the right internal jugular vein and extends into the superior vena cava.
1. Interval decrease in size of metastatic lymph nodes in left neck. 2. Lymph node changes consistent with necrosis in response to treatment.3. No CT findings of recurrence at site of tumor resection.