54-year-old male with head and neck cancer, evaluate response to therapy CHEST:LUNGS AND PLEURA: Scattered areas of scarring in both lungs are unchanged. Volume loss in the left lower lobe. No suspicious nodules or masses can be identified. No evidence of pleural effusion. Bronchial wall thickening, particularly at the left lung base is unchanged. The left upper lobe mucoid impaction is stable.Mild paraseptal and centrilobular emphysema.MEDIASTINUM AND HILA: Tracheostomy tube in place. Right Port-A-Cath with its tip in the SVC. Mediastinal lymph node enlargement is stable.CHEST WALL: Right chest port. Soft tissue collection of air is identified in the region of the right subclavian vein may be secondary to recent instrumentation. Increasing areas of sclerosis involving the T1, T2, and T3 vertebrae may be near the radiation therapy. Osseous metastases cannot be definitely excluded. MRI of the cervical and thoracic spine is recommended. Large soft tissue mass in the lower portion of the left neck partially visualized on this exam. Will be evaluated on CT of the head and neckABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube in placeBONES, SOFT TISSUES: Sclerotic areas in the upper vertebrae and impending collapse of the T2 vertebrae may represent post radiation changes and/or metastatic disease.OTHER: No significant abnormality noted
1.No evidence of pulmonary metastatic disease. Stable mediastinal adenopathy.2.Low left neck mass better evaluated on CT of the head and neck.3.Sclerotic lesions in the T1, T2, T3 vertebrae with impending collapse of the T2 vertebrae may represent post radiation changes or metastatic disease. Recommend MRI and he cervical and thoracic spine for further evaluation.