Male, 65 years old, with esophageal ulceration and bone exposure. Again seen is a defect or ulceration of the right posterior hypopharyngeal mucosa spanning the C4 and C5 levels. Pooling fluid and/or inflamed supraglottic mucosa partially fills the defect. The defect extends up to the anterior margin of the vertebral bodies.The mucosa and paravertebral soft tissues adjacent to the defect are edematous and enhancing. However, no discrete or rim-enhancing fluid collections are identified. As on the prior examination, the marrow of the C4 and to a lesser degree the C5 vertebrae is slightly T1 hypointense. However, there is no STIR signal abnormality within the marrow or intervening disc spaces. Postcontrast images demonstrate relatively heterogeneous enhancement throughout the cervical marrow which may reflect the effects of prior radiotherapy. Again seen is evidence of right IJ vein thrombosis.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. The visualized spinal cord shows normal signal intensity and morphology. No epidural lesions are suspected. Relatively mild disc osteophyte formation is seen through the cervical region. No areas of high-grade spinal canal or foraminal stenosis are observed.
An ulceration is redemonstrated along the right posterior hypopharyngeal wall at the C4 and C5 levels. Although the adjacent supraglottic mucosa and paravertebral soft tissues are edematous, no evidence of abscess is seen. There is mild T1 signal abnormality within the marrow of the C4 and C5 vertebrae. However, the complete absence of any pathologic STIR signal to suggest edema in the marrow space or discs would argue against osteomyelitis.