Parotid cancer status post surgery and radiation. Neck CT:There has been interval decrease in volume of the hyperintense right parotid tissues. No discrete mass is identified. There are scattered small lymph nodes in bilateral neck, unchanged in size, and are within normal limits based on size criteria.In the right shoulder, at the right supraspinatus muscle, there is new hypodense lesion, seen on coronal image number 27 of series 80380, and axial image 63 series 4. The clinical significance is uncertain, but given the history of adenocystic carcinoma, unusual distant metastasis needs to be considered. Further evaluation with right shoulder MRI without and with contrast is recommended.There is minimal mucosal thickening in right mastoid air cells and left maxillary sinus.The osseous structures and limited view of the upper lungs appear unremarkable for metastatic disease.
1. Interval decrease of right parotid tissues with asymmetric hypodensity, probably related to post treatment changes. No evidence of tumor recurrence or adenopathy in the neck.2. New hypodense lesion in the right shoulder at the supraspinatus muscle. Although this can represent benign musculoskeletal disease, distant metastasis cannot be excluded. Further evaluation with right shoulder MRI without and with contrast is recommended.