60 year-old male with history of left nasal vestibule is squamous cell carcinoma involving left lateral nasal wall. Now status-post left medial maxillectomy and ethmoidectomy. Has granulation tissue, possible requirements left superior/anterior nasal area. Please evaluate and stage. Enhanced CT of soft tissues of neck:In comparison with prior examination there is interval resolution of previously noted soft tissue densities within the left frontal sinus and left ethmoid sinus region which is leave to have represented mucosal thickening and inflammatory changes. There is no definitive evidence of interval new bony changes.Images through the nasal cavity demonstrate overall decrease in the amount of soft tissue density that was present in the left nasal cavity. On coronal reformatted image 14 in the most anterior aspect of the left nasal cavity the soft tissue within the nasal cavity demonstrate subtle enhancement. This finding measures approximately 12 mm in cranial cephalad access and 7-mm in transverse axis. Although this finding may represent postop scarring considering the provided clinical data it may represent recurrence of tumor. This finding could be better evaluated with a dedicated MRI of maxillofacial region. On axial image 16 this tissue appears to extend beyond the confinement of nasal cavity and into the soft tissues of the nose. There is no detectable new bony changes since prior study.Residual mucosal thickening within the left maxillary sinus.Images through the skull base remain unremarkable.Images through the neck demonstrate multiple small nonenhancing and not pathologic by CT size criteria lymph nodes which were present and read no detectable change since prior study from 2009. There is no evidence of any pathologic lymph nodes in the neck.No evidence of osseous or cartilaginous erosion.Heterogeneously enlarged right lobe of thyroid is consistent with goiter. This finding was also present on prior study.Limited images of the apices of the lungs and mediastinum are negative.Enhanced CT of brain:There is no evidence of intracranial metastatic lesion. Calvarium is intact.Findings consistent with small vessel disease are again identified and made no gross interval change since prior study from 2009.80 CT of Omnipaque 350 was administered for the above studies.
1.Interval decrease in the amount of soft tissue within the left nasal cavity compared to prior nonenhanced CT of the maxillofacial region. A small enhancing tissue in the anterior aspect of the left nasal cavity may represent recurrence of tumor as detailed above. Further evaluation with a dedicated enhanced MRI is recommended since this finding could also conceivably represent postoperative scarring. This finding is not associated with any new bony changes.2.Stable CT examination through the rest of soft tissues of neck and with no evidence of pathologic adenopathy.3.No evidence of metastatic disease to the brain or calvarium. Findings of small vessel disease remains grossly stable since prior study.