60 year-old male with right maxillary squamous cell carcinoma, status post induction chemotherapy, for the study. Brain CT:The attenuation and morphology of the brain parenchyma is within normal limits for patient's stated age. No evidence of hemorrhage, edema, mass-effect, midline shift, no abnormal enhancement in the brain parenchyma is detected. Ill-defined linear enhancement identified along the right side medial aspect of the middle cranial fossa contiguous with right foramen ovale and along the cavernous sinus seen on the prior MRI is not as well appreciated on this CT study. Cortical sulci, ventricular system and all basal cisterns are normal in size and configuration. Partial opacification of right mastoid air cells is redemonstrated. Neck CT:There is mottled radiolucent destruction involving right side hard palate, medial and lateral pterygoid plate, greater wing of sphenoid and the posterior wall of right maxillary sinus. The right vidian canal is not visualized. The right maxillary sinus soft tissue mass appears to have been largely resected. There is residual soft tissue thickening along the wall of the right maxillary sinus and status post uncinectomy and partial turbinectomy change. Soft tissue enhancement/irregularity in right pterygopalatine fossa and masticator space are persistent. The parapharyngeal space is preserved. Views of soft tissue neck is negative for discrete mass. No pathologic lymphadenopathy is appreciated based on the size criteria for lymphadenopathy. Scattered small lymph nodes are seen in bilateral level II to IV . A retention cyst is again noted in left maxillary sinus.The airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The visualized portion of the lungs are clear. Please refer to the dedicated chest CT for more comments. The cervical vertebral bodies in general are intact with no evidence for canal stenosis.
1. Interval post surgery and treatment change in the right maxillary sinus region. There is residual soft tissue thickening along the the maxillary wall. Soft tissue enhancement/irregularity in right pterygopalatine fossa, masticator space are persistent. These findings can represent residual tumor.2. There is no pathologic lymphadenopathy based on radiological criteria.3. Ill-defined linear enhancement in medial aspect of the middle cranial fossa along the lateral cavernous sinus, contiguous with right foramen ovale erosion. These findings were better seen on prior MRI and could represent intracranial spread. They are less well appreciated on this CT, and it is uncertain whether this is secondary to interval improvement or differences in techniques.4. Right mastoid, left maxillary sinus inflammatory change.