Clinical question: Metastatic thyroid cancer to bone, brain and lung. Pre-chemotherapy. Signs and symptoms: metastatic thyroid cancer. Enhanced CT of soft tissues of neck:Limited view of intracranial content demonstrates small enhancing metastatic lesion in the left frontal lobe measuring 7-mm times 10-mm. This could be further evaluated on dedicated CT of brain.Images through the skull base demonstrate a lytic lesion in the clivus with no change since prior exam. This lesion has a sclerotic rim. This is believed to represent postoperative changes of the sphenoid sinus with packing material.Cavernous sinuses and bilateral Petrus bones remain within normal limits.Images through the neck and demonstrate no evidence of a mass or pathologic adenopathy. No evidence of residual enhancing thyroid tissue. The esophagus appears dilated and contains air. This may represent reflux. Trachea appears ectatic.CT of brain with enhancement: Lytic changes of clivus with a sclerotic rim and internal calcific fragments remains stable since prior CT of head and neck study and MRI of brain. This lesion believed to represent non-pneumatized sphenoid sinus or may be result of prior surgical inflammation (transphenoidal hypophysectomy) and with packing of the sinus. There is no interval change since prior exams and there is no abnormal enhancement of this finding on MRI examination. Please correlate with patient's past history.Images through the posterior fossa demonstrate a well demarcated low-attenuation within the vermis with no enhancement at the site of previously noted metastatic lesion. Surrounding vasogenic edema still is present. The finding may represent post treated metastatic lesion. This lesion measures approximately 16.2 mm in transverse axis and 14.4-mm in AP axis. This is a smaller than prior measurements of the enhancing mass in this location which measured 21 mm times 18-mm.At enhancing tumor measuring approximately 9 mm times 7-mm in the inferior left frontal lobe with surrounding vasogenic edema is again identified. This mass on prior MRI examination measured 5-mm x 4.5-mm. there is no evidence of any new additional metastatic lesions to the brain or leptomeninges.Calvarium is intact. 65 cc of Omnipaque 350 was utilized for the above studies.
1.Stable CT of soft tissues of neck with no evidence of recurrence of tumor or pathologic adenopathy in neck.2.Minimally larger left inferior frontal metastatic focus with surrounding vasogenic edema. This lesion measures 7 mm times 9-mm on current exam.3.Patient is known enhancing metastatic lesion in the vermis demonstrates no enhancement on the current exam and measures smaller than prior exam.4.No evidence of new additional metastatic lesion to the brain or calvarium.