67-year-old male with history of lung and larynx cancer. Had resection of lung and larynx, XRT. Recurred in the larynx and had salvage laryngectomy with free flap. Assess for possible recurrence versus new cancer. He CT of the soft tissues of the neck without contrast:Images through the skull base and including the region of cavernous sinuses, all paranasal sinuses and mastoid air cells remain unremarkable.Images through the neck demonstrate heavy calcification of the carotid bifurcations bilaterally. Post operative changes on the right side of the neck with multiple clips are noted. Extensive postoperative changes of laryngectomy is noted. Postoperative changes of midline free flap placement.No evidence of a mass or pathologic adenopathy neck.Limited images of the apices of the lungs and mediastinum demonstrate minimal apical scarring and emphysematous changes. Please review the dictated report of CT of chest which demonstrates both these regions with better advantage. Bony structures of the area of the exam are negative for metastatic lesions.CT of brain without the infusion:Large vessel intracranial vascular calcification is noted. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal for patient stated age. Calvarium demonstrates multiple areas of sclerotic change which were present on the prior examination from T. -- 6/2009 and read no interval change. To exclude metastatic lesion and MRI or bone scan is recommended.
1.Negative non-a diffuse CT of soft tissues of the neck for recurrence of disease.2.Negative CT of brain without infusion.3.Multiple patchy areas of the sclerotic changes of calvarium is stable since prior multiple studies. To exclude metastases nuclear medicine study or MRI is recommended.