59 year old male with history of thyroid cancer with metastases. Status post resection, brain irradiation, chemotherapy. On clinical trial. CT of the soft tissues of the neck.Images through the skull base including cavernous sinuses are within normal limits.Images through the soft tissues of the neck demonstrate a well demarcated enhancement involving the posterior wall of nasopharynx (axial image 24 through 28). There is no evidence of an increased soft tissue mass with this finding. All of the prior studies where re-examined and demonstrated the same finding with no interval change. The exact etiology of this finding is not clear. Possibility of a tumor would be considered very low considering its stable appearance since 4 -- 28 -- 2008. An MRI may be helpful to precisely determine the etiology of this finding. This finding does not appear as a postsurgical change.An enhancing right posterior triangular lymph nodes on axial image 35 is again identified and no interval change since prior study. This node measures identical to the prior exam and is 10 mm times 11.8-mm in size.A smaller enhancing right posterior triangular lymph nodes is again also identified with no interval change. Enhancement could appearance of a central necrosis immediately medial to the right internal carotid artery is believed to represent a Trumbull was to jugular vein. This finding is also stable since prior exam (axial image 34 through 39).Extensive post therapy changes of the soft tissues of the neck with distortion of anatomy is again identified. No definitive evidence of recurrence of tumor or pathologic adenopathy. Extensive metastatic lesion two bilateral upper lung fields are noted. Please review the dictated report of CT of chest. No osseous metastatic lesion.CT of brain with infusion.Multiple small supra-and infratentorial foci of increased density (cannot be certain whether they represent small calcific post treated metastases or enhancement) are again identified and with no interval change. No evidence of new lesions is identified. No evidence of hemorrhage, edema, midline shift or hydrocephalus.
1.Stable CT examination of soft tissues of the neck and with no definitive evidence of recurrence of tumor or pathologic adenopathy. Please see above comments.2.Stable findings on CT of brain which may represent post treated metastatic lesions.