 There is large enhancing infiltrative mass centered within the mucosal space of the nasopharynx. It is difficult to measure accurately due to its infiltrative nature, however, it measures approximately 70 mm in transverse dimension. There is enhancement of the bilateral torus tubari extending into the eustachian tubes, right greater than left, with extension into the bilateral masticator space, again right greater than left, including the bilateral medial pterygoid and right lateral pterygoid muscles. There is extension into the right post maxillary fat, right sphenopalatine foramen and pterygopalatine fossa, through the right foramen rotundum and foramen ovale with extension into the right cavernous sinus, and the floor of the right anterior middle cranial fossa where there is dural thickening. There is asymmetrically prominent enhancement of the mastoid segment of the right facial nerve. There is questionable infiltration and enhancement of the clivus as well. There is partially imaged bilateral cervical lymphadenopathy, including a left intraparotid node.The internal auditory canals are symmetrical and normal in size. The inner ears are normal. There is no mass. There is fluid within the right mastoid air cells and middle ear cavity that is likely secondary to eustachian tube obstruction. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.
1.Large infiltrative bilaterl nasopharyngeal masses ( R>L). There is perineural tumor spread through the right foramen rotundum and foramen ovale as well as possibly along the right facial nerve. The findings are most compatible with lymphoma, among other neoplastic etiologies. 2.Partially imaged cervical lymphadenopathy .3.Further evaluation with a dedicated CT neck soft tissues with contrast is suggested.These findings were discussed with Dr. Gluth at 1 p.m. on 3/25/2015.