Clinical question: Baseline scan prior to new treatment start following disease progression. Signs and symptoms: History of stage IV metastatic melanoma. Enhanced CT of soft tissues of neck:60 cc of Omnipaque 350 is administered for this exam.Limited view of intracranial space demonstrate a large area of vasogenic edema in the right mid and posterior temporal lobe. There is a partially visualized enhancing mass in the right posterior temporal lobe measuring 13 x 14.2-mm in size.This finding was reported on prior MRI examination of brain from 6 -- 28 -- 11.Images through the skull base including cavernous sinuses are unremarkable.A right-sided nasopharyngeal mass is again identified. In comparison to prior study from 5 -- 16 -- 11 there is interval decrease in the size of the tumor. This mass extends along the posterior wall of the nasopharynx across the midline to the left paramedian left side of nasopharynx. The largest AP axis of this tumor is 18.6 and the largest transverse axis is 32.6-mm. These measurements are smaller since prior study. On the prior exam note was also made of extension of this tumor into the right posterior choana of the right nasal cavity which is no longer present on current study.A small subcutaneous metastatic nodule or on the left at C4 level demonstrate interval increase in its size to 18.6 x 20.6-mm in size while it measured only 9 x 6-mm on prior study.A small necrotic node in the left submandibular region remains identical to prior study and measures approximately 6.5 mm.No additional foci of metastatic lesions are identified.There is no definitive evidence of any osseous metastatic lesions. Please review dedicated studies for detection of osseous metastases.
1.Interval decrease in the size of right-sided nasopharyngeal mass since prior study. The largest dimensions of this mass are 18.6 x 32.6 millimeter.2.Interval increase in the size of a left posterior upper neck subcutaneous metastases lesion from 9 x 6-mm to 18.6 x 20.6-mm on current exam. 3.No evidence of neoplastic lesions.4.Large area of vasogenic edema in the right mid to posterior temporal lobe surrounding an enhancing tumor measuring 13 x 14.2-mm in size.