Male, 59 years old, with history of metastatic thyroid cancer. Evaluate for treatment. Brain:No evidence of mass, mass effect, edema, or pathologic enhancement is seen to suggest intracranial metastatic disease.Diffusion-weighted images are unremarkable. Brain parenchymal morphology is within normal limits. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is detected. Ventricles are normal in size and morphology.Neck:Thyroid tissue is not clearly recognized compatible with thyroidectomy. No obvious tumor like lesions are seen within the thyroid bed.T2 hyperintensity and enhancement are seen within the proximal right clavicle, the right aspect of the manubrium and in the surrounding soft tissues. A prominent sternomanubrial joint effusion is also seen.No definite pathologic adenopathy is seen in the neck. The salivary glands are unremarkable. Note is made of medialization of the vocal folds on the right which may reflect dysfunction of the recurrent laryngeal nerve.Multiple marrow replacing lesions are demonstrated within the visualized spine including C6, C7 and T2.Brachial plexus:The nerves of the brachial plexus demonstrate normal morphology and course. No evidence of thickening, pathologic enhancement or impingement is seen.Note is made of atrophy and mild T2 signal abnormality affecting the right trapezius muscle which may reflect a denervation effect. Degenerative joint disease is also seen at the right acromioclavicular joint.
1.Unremarkable evaluation of the brain with no evidence of metastatic disease.2.Evidence of thyroidectomy in the neck with no definite tumor like lesions in the thyroid bed or pathologic adenopathy in the neck. Findings are seen suggestive of right recurrent laryngeal nerve dysfunction.3.Marrow edema and enhancement affects the proximal right clavicle and the right aspect of the manubrium. This region is hypermetabolic on a recent PET scan, the CT portion of which also demonstrates some mild associated bony erosion. Findings are concerning for a site of metastatic disease, though an inflammatory process or severe osteoarthritic degeneration can also be considered.4.Multiple metastatic lesions are suspected within the cervical vertebrae as above.5.No specific abnormalities of the brachial plexi are suspected. Note is made of atrophy and abnormal signal affecting the right trapezius muscle which may represent an effect of denervation.