Evaluate for retropharyngeal abscess. Patient is status post tracheostomy with signs of abscess on endoscopy. Neck CT:Again noted is bone and disk space destruction consistent with diskitis - osteomyelitis at C5, C6, and C7 levels as reported on recent CT study. Kyphotic angulation at the level of diskitis - osteomyelitis, with uncovering of bilateral C5 - C6 facet joints are again noted. Again noted are postsurgical changes of laminectomy. A thin layer of epidural abscess is again seen along the posterior longitudinal ligament of the cervical spine as described on prior MRI of cervical spine.There is significant heterogeneous soft tissue thickening involving the prevertebral space, retropharyngeal space and pharyngeal mucosal space, extending from the level of C2 - C3 to C7 - T1 level, superior to the tracheostomy tube placement. There is air tracking in the prevertebral space. Given the presence of osteomyelitis - diskitis, this probably represents acute inflammatory changes and phlegmon. However, there is no discrete fluid collection to suggest retropharyngeal abscess. Presence of soft tissue mass in hypopharynx representing tumor recurrence cannot be excluded.There is left pleural effusion. There are emphysematous changes in the lung apices.There is bony erosion of anterior left paramedian region of the left maxillary alveolus. This is unchanged.
1. Diskitis - osteomyelitis involving C5, C6, and C7 levels with kyphotic angulation of the cervical spine and uncovering / subluxation of the bilateral C5-C6 facet joints.2. Small residual epidural abcess in cervical spine.3. Heterogeneous soft tissue thickening involving the hypopharynx, extending from pharyngeal mucosal space to retropharyngeal space, with air tracking in the prevertebral space, likely representing a combination of inflammatory soft tissue edema and phlegmon. No evidence of discrete abscess in retropharyngeal space. Presence of recurrent tumor in the hypopharynx cannot be excluded based on imaging appearance.4. Left pleural effusion.