Clinical question: History of recent head and neck cancer, post surgery, pre-chemotherapy/RT. Signs and symptoms: Baseline chemo/RT CT of soft tissues of neck with contrast:70 cc of Omnipaque 350 was utilized for the above study.Images through the skull base, cavernous sinuses, paranasal sinuses and mastoid air cells are unremarkable. There is evidence of thrombosed right internal jugular vein that appears to extend into the right jugular bulb. This is a new finding since prior study. There is expansion of thrombosed right internal jugular from the skull base to approximately the level of the right carotid bifurcation.Examination demonstrates extensive postoperative changes of right neck with a large flap which extends from the right submandibular level inferiorly to the level of the right thyroid cartilage. There is evidence of partial right mandibulectomy. There is fixating screws and rod extending from anterior aspect of remaining right body of mandible posteriorly to the ramus of mandible.Postoperative changes in the including multiple surgical clips near right submandibular region are noted. This is also believed to be related to surgical changes of the lack placement.There is no definite differential mass or pathologic adenopathy by CT size criteria is identified. There is a small cyst within the right lobe of thyroid measuring approximately 10.5 mm times 7-mm on coronal reformatted image 39.Limited images of the apices of the lungs and mediastinum are negative. Please review dedicated report of CT of chest which visualizes both of these regions would better advantage.The osseous structures of the area of exam other than what was noted in the mandible are unremarkable. No evidence of cartilaginous erosion. The carotid system is intact.CT of brain with contrast:Examination demonstrates an enhancing mass measuring approximately 8 mm times 5 mm in transaxial dimension in the body of the left lateral ventricle. The mass is well demarcated and demonstrates uniform intense enhancement. No definitive calcification is detected. There is no associated edema of the adjacent brain parenchyma. Considering patient's history of malignancy metastatic lesion should be considered. Other differentials for this mass includes intraventricular meningioma, great plexus papilloma, ependymoma and other lesions. Follow up with a dedicated MRI may help in differentiating the etiology of this finding.There is no evidence of any additional area of abnormal enhancement. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Gray/white matter differentiation is well preserved.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are unremarkable.There is redemonstration of thrombosed and expanded right jugular vein in upper cervical with apparent extension into the right jugular bulb.
1.Extensive postoperative changes of the neck on the right with no detectable tumor or pathologic adenopathy.2.Well demarcated a small mass within the body of left lateral ventricle (5-mm times 8mm) as detailed. Differential includes metastatic lesion, meningioma, ependymoma and choroid plexus papilloma. Considering the history of malignancy metastatic disease should be considered and follow-up with an MRI is recommended.3.CT examination of brain and calvarium is otherwise unremarkable for malignancy.4.Thrombosed right jugular vein in upper cervical region and with apparent extension into the right jugular bulb.