Reason: Patient with h/o scalp lesion that has increased in size over the last year. Patient presents today with new neck mass, please evaluate. Brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are subdural effusions present bilaterally and symmetrically measuring up to 9 mm in thickness within the supratentorial brain there are subdural effusions in the posterior fossa measuring up to 10 mm in thickness. These are likely related to brain atrophy.There is a mass present along the scalp soft tissues extending to the level of the calvarium just behind the level of the coronal suture eccentric to the left side just to the left of midline measuring 50 x 22 mm in sagittal dimensions and 60 x 22 mm in coronal dimensions. It does not invade the marrow. It is visually contiguous with the calvarium.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus which has high signal on T1 and intermediate signal on T2 suggestive of inspissated secretions.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Neck:There is a 36 x 26 mm axial dimension mass at the left posterior triangle which abuts the left carotid sheath at the level of the angle of the mandible. It has some heterogeneous enhancement. It is heterogeneous in signal on T1 and T2-weighted imaging. It is well-circumscribed. It is bright on diffusion-weighted imaging and low signal on ADC map suggesting diffusion restriction.There is a 20 x 13 mm axial dimension lesion just behind the left submandibular gland which has similar signal characteristics to the above described lesion. Smaller similar lesions are present in the right submandibular space just behind the submandibular gland measuring 15 x 7 mm and scattered elsewhere.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact . There are degenerative changes present in the cervical spine with narrowing of the spinal canal at C3-4, C4-5, C5-6 and C6-7 suspicious for spinal stenosis. There is also suspicion for multilevel neural foramen encroachment of exiting nerve roots.Diffuse marrow replacement in the visualized portions of the cervical spine is a nonspecific finding which could relate to anemia, lymphoproliferative disorder, or chronic disease.
1.There is a mass present within the scalp soft tissues adjacent to the left parietal bone. Although it abuts the left parietal bone, there is no convincing evidence that it invades it. If clinically appropriate a CT of the head may be useful in determining whether there is calvarial erosion.2.A large mass in the suprahyoid neck along the posterior triangle on the left side just behind the left carotid sheath. This location would indicate this most likely represents lymphadenopathy. An additional similar lesion in the left submandibular space is also suspected to represent lymphadenopathy. Smaller lymph nodes not meeting size criteria for adenopathy or present throughout the soft tissues of the neck.3.There are multilevel degenerative changes present cervical spine with findings suspicious for spinal stenosis at multiple levels and multilevel neural foramen encroachment.4.Diffuse marrow replacement in the visualized portions of the cervical spine is a nonspecific finding which could relate to anemia, lymphoproliferative disorder, or chronic disease.