History of salivary cancer status post surgery and radiation now with draining fistula over the right clavicle. Evaluate for underlying cancer recurrence or abscess. Redemonstration of extensive soft tissue thickening in the right supraclavicular region. This appears long-standing based on prior imaging and favored to represent scarring. Within this area of soft tissue thickening there is a small fluid collection located superior to the clavicle, anterior to the scalene muscles, and lateral to the carotid sheath measuring approximately 10 x 10 mm in axial dimension and 16 mm craniocaudal. (Series 7 image 34). Postcontrast images show poorly defined enhancement surrounding this fluid collection (11 image 34 and 35). A sinus tract is identified tracking superiorly to the skin (series 8 image 26, 25, and 24). Based on the pattern of enhancement, this is most compatible with an infectious process with a central abscess. Infiltrative tumor with a necrotic core remains a diagnostic consideration, however this is considered less likely given absence of a discrete solid underlying mass.Remainder the neck demonstrates extensive post surgical changes with neck dissection. Soft tissue thickening and edema involving the supraglottic structures is compatible with posttreatment changes. No definite recurrent tumor or lymphadenopathy is identified.Post surgical changes involving the right mandible. Heterogeneous signal within the mandible and clavicular heads compatible with radiation change as seen on prior CTs. Multilevel degenerative changes in the cervical spine with partial fusion of the C4 and C5 vertebral bodies again seen. The orbits and paranasal sinuses are unremarkable. The visualized intracranial contents are unremarkable without mass, mass effect, midline shift, or abnormal enhancement. There is partial opacification of the bilateral mastoid air cells.
1. 10 x 10 x 16 mm diameter fluid collection in the right supraclavicular region with draining sinus tract extending to the skin anterosuperiorly. The pattern of enhancement surrounding the collection favors an abscess. Infiltrative recurrent tumor with a necrotic core remains a differential consideration, but seems less likely as the extensive surrounding infiltrative soft tissue thickening appears long-standing based on multiple prior CT studies.2. Extensive posttreatment changes throughout the neck as described without convincing evidence of recurrent tumor or lymphadenopathy.