Cervical lymph node enlargement. Neck Mass. CT of the soft tissues of the neck with infusion:Images through the skull base, cavernous sinuses, paranasal sinuses and petrous bones are free of malignancy and unremarkable.Previously noted right tonsillar mass is no longer identified. There is no evidence of any measurable mass. Very minimal soft tissue thickening however still is present.A necrotic right-sided lymph node is again identified. This finding measures 23.5-mm x 21.5-mm (axial image 38 of 82) in transaxial dimension. The measurement of this node on the prior examination was 22.9-mm times 20.9-mm.This node is at the level of the right carotid bifurcation and appears to partially encase right internal carotid artery, right carotid bifurcation and possibly of the proximal right external carotid artery. The overall appearance of this finding (although not typical), its location and relation with carotid and lack of any interval change since prior examination also raises the possibility of a thrombosed carotid aneurysm. Extreme close proximity of this finding with the carotid warrants further evaluation in particular with an MRI.There is no evidence of any new lymphadenopathy.Limited images through the mediastinum are intact.Limited images through the apices of the lungs are unremarkable. 100 cc of Omnipaque 350 was utilized for the above study.
1.No evidence of a mass in the soft tissues of the neck. Previously noted soft tissue mass in the right tonsil is no longer identified.2.Unusual appearance of the right cervical lymph node with very close proximity and encasement of the carotid as detailed above. This finding demonstrates no interval change since prior study. Its overall unusual appearance, close proximity to the carotid, no appreciable interval change since prior exam warrants further evaluation with an MRI examination to entirely exclude possibility of a vascular abnormality (aneurysm).3.A message was left on Dr. Joyner office number regarding the findings on this patient.