History of left neck carcinoma. Question of pulmonary embolism. Complains of acute onset shortness of breath. Likely PE but also evaluate for possible mass effect on trachea.IMAGE ACQUISITIONS: CT neck soft tissues with contrast. On the uppermost image of the neck CT, the previously noted right parietal metastasis is again seen and measures 19 x 19 mm, minimally larger than the comparison brain MRI.There has been interval growth of the left neck mass . At the level of the vocal cords the airway appears narrowed although this is more likely due to a left vocal cord paralysis than direct mass effect. More inferiorly the trachea does appear slightly narrowed by mass effect. The mass measures 67 x 80 mm transaxially and 90 mm in the craniocaudad dimension. Note that the inferior margin of this mass extends into the superior mediastinum. Multiple new enhancing lymph nodes are seen in the left posterior neck, the two largest of these measure 11 mm in diameter. The right jugular vein is thrombosed. Within the isthmus of the thyroid there is a central low attenuation region which may represent a new thyroid metastasis.
1. Asymmetric narrowing at the level of the vocal cords more likely due to left vocal cord nerve paralysis. Inferior to this level there is slight narrowing of the trachea due to mass effect.2. Progression of disease in the neck with enlargement of the mass as well small small new pathologic lymph nodes, and likely new thyroid metastasis.3. Right parietal brain metastasis is incompletely visualized but appears slightly larger than the comparison MRI brain exam.4. Right internal jugular vein thrombosis.