Recurrent laryngeal malignancy. Status post radiation treatment and multiple laryngeal procedures at outside hospital.Additional clinical history from electronic medical records: Recurrent laryngeal cancer; status post radiotherapy in 2012. He presented in February 2016 with a right neck mass resection of which showed squamous carcinoma with extracapsular extension. This may represent metastasis/recurrence of the original laryngeal carcinoma or may represent nodal metastasis from new head and neck primary cancer. There is a tracheostomy as well as changes of previous total laryngectomy. There is a pectoralis major flap in the right side of the neck. There is nodular contrast enhancement along the superior margin of the flap extending posterior and medial to the right parotid gland into the parapharyngeal space, which is the site of the most recently resected nodal mass. However, there is no discernible mass and there was no significant FDG activity in this region on the recent PET CT scan. Additionally, the medialized retropharyngeal course of the right internal carotid artery is probably also contributing to the asymmetric contrast enhancement in the area. There is no discrete cervical lymph node enlargement. Small, left more than right level 1B lymph nodes and tiny level 1A lymph nodes are not changed from the previous CT scan and showed only mild FDG activity on the recent PET/CT scan.There is slight asymmetric right-sided mucosal thickening along the upper end of the neopharynx but no discrete mass, which correlated with FDG avidity on the recent PET. This asymmetry also extends along the right side of the base of the tongue. An eccentric atheroma, versus intramural hematoma, involves the right common carotid artery and is not significantly changed compared to the previous CT scan, resulting in moderate stenosis. The right internal jugular vein is not visualized, probably ligated.Otherwise, the thyroid and major salivary glands are unremarkable. The cervical spinal canal is developmentally narrow. There is multilevel cervical degenerative spondylosis, most pronounced at C6-C7 where disc-osteophyte complex and ligamentum flavum thickening result in mild-to-moderate spinal canal stenosis. Focal marrow abnormality subjacent to the inferior endplates of C3 and C6 most probably represent intrabody disc herniations. There is no suspicious marrow lesion. There is fatty atrophy, increased STIR signal and contrast enhancement in the right hemitongue and the right trapezius muscle. There is small volume of fluid within the posterior naso/oro/neopharynx. There is mild mucosal thickening in the paranasal sinuses. There is fluid intensity in the right mastoid air cells. The imaged intracranial structures are unremarkable.
1.Contrast-enhancement posterior and deep to the right parotid gland, at the site of the recent nodal resection, is favored to be postoperative in nature given the lack of a discrete mass as well as the lack of significant FDG activity on the recent PET. 2.Asymmetric right-sided thickening in the oropharynx/upper neopharynx without a discrete mass might be inflammatory/postoperative in nature but is better assessed clinically. 3.Otherwise, expected postoperative changes are present in the neck as described above. 4.Small level 1 lymph nodes remain unchanged. No cervical lymph node enlargement by size criteria.5.Incidental finding of right carotid artery mural hematoma relating to dissection versus asymmetric atherosclerotic plaque, resulting in more than 50% luminal narrowing but unchanged since February 2016 examination.6.Right hemitongue and trapezius muscle abnormal signal and enhancement, likely relating to denervation of 11th and 12th cranial nerves.