Neck mass concerning for carotid artery invasion with history of T4N2b left oropharyngeal squamous cell carcinoma and concurrent laryngeal squamous cell carcinoma treated with chemo and radiation last in 1/2015), myasthenia gravis, and left internal jugular vein thrombosis (on lovenox). There are post-treatment findings in the upper aerodigestive track related to radiation therapy and tracheostomy tube insertion. There is an ulcerative mass with central hypoenhancing areas and peripheral ill-defined enhancement centered within the left oropharyngeal space that measures up to approximately 4.5 cm. The abnormal enhancement extends to the retropharyngeal space, prevertebral space, left masticator space, and left parapharyngeal space, at least partially surrounding the left internal carotid artery. There is no significant lymphadenopathy in the neck. There is heterogeneous enhancement and ill-defined swelling in the posterior hypopharynx as well, but otherwise no measurable mass in the larynx. There is left tympanomastoid fluid. There is scattered paranasal sinus mucosal thickening. There is deformity and expansion of posterior right ribs, which may be related to prior fracture.
Findings suggestive of tumor progression with substantial areas of necrosis centered within the left oropharyngeal space that measures up to approximately 4.5 cm. Heterogeneous enhancement and ill-defined swelling in the posterior hypopharynx may represent tumor versus treatment effects. Please also refer to the recent prior CTA for additional details regarding the status of the carotid artery.Discussed with Dr. Haraf at 2:30 PM on 6/15/15.