 Note that the lack of intravenous contrast limits evaluation. There is skin thickening and edema in the posterior upper cervical subcutaneous soft tissues, right greater than left. Edema extends to the right parotid gland and to the level of the neck muscles without deeper extension into the spine. There are no measurable discrete fluid collection. There are areas of diffusion restriction in the previous identified discrete ovoid areas of soft tissue density, which are consistent with phlegmon or early abscess formation. The right parotid gland is mildly enlarged which may be reactive. There are scattered prominent lymph nodes. Nasopharynx, oropharynx, and hypopharynx are patent. The submandibular glands are normal in appearance. There are no thyroid masses. There is layering frothy material in the bilateral sphenoid sinuses with mild mucosal thickening. Minimal mucosal thickening is also noted in the bilateral maxillary sinuses. The bilateral mastoid air cells are partially opacified. Bilateral lens prostheses noted.Limited evaluation of the brain parenchyma demonstrates a focus of increased T2 signal in the left anterolateral thalamus which may be related to prior ischemic injury. There are multilevel degenerative changes in the cervical spine with disc bulge and moderate spinal canal narrowing at C4-C5. Expected vascular flow voids are present demonstrating patency.
1.As seen on recent CT, there are extensive inflammatory changes in the soft tissues of the posterior neck which on the right extend to the level of the right parotid gland. These findings are consistent with extensive cellulitis. Multiple areas within the superficial soft tissues demonstrate restricted diffusion which may be related to phlegmon or early abscess formation. No discrete drainable fluid collection is demonstrated although the lack of contrast limits evaluation. Inflammatory changes extend to the posterior paraspinous musculature without deeper extension into the spinal canal.2.Mild paranasal sinus disease.3.Degenerative changes in the spine with moderate spinal canal narrowing at C4-C5.