97-year-old male with neck pain, new onset.? Mass exam. Also with weight loss. Evaluate for mass,? Malignancy Enhanced CT of soft tissues of neck:Images through the skull base, cavernous sinuses, orbits, paranasal sinuses and petrous bones are unremarkable.There is no evidence of a mass or pathologic adenopathy in the neck. Multiple small nonenhancing, non-necrotic and nonpathologic by CT size criteria lymph nodes are noted on the right side of neck and to a lesser degree on the left. The largest of these nodes measures 12 mm x 9.8-mm in the right neck at the level of right thyroid lobe (axial image 71). The vasculature of the neck is intact. No evidence of erosive bony or cartilaginous lesions. He limited images of the apices of the lungs are unremarkable.Extensive degenerative changes of the cervical spine with slight reversal of cervical lordosis is noted. Degenerative changes are more pronounced at C5 -- C6 level. There is multi-level neural foramina compromise at C2 -- C3 on the right, C3 -- C4 bilaterally, C4 -- C5 bilaterally, C5 -- C6 bilaterally (most severe) and C6 and C7 levels. There is also highly suspected central spinal stenosis at multiple levels which can be further evaluated with a dedicated MRI of the cervical spine. CT examination is insensitive to detect central spinal stenosis due to soft tissue hypertrophic changes (disk material or hypertrophic soft tissue changes of the ligaments).80 CC of Omnipaque 350 was utilized for the above study.
1.No evidence of a mass in the soft tissues of the neck.2.Multiple small nonenhancing, non-necrotic and nonpathologic by CT size criteria lymph nodes as detailed above.3.Extensive degenerative changes of cervical spine with multilevel bilateral neural foramina compromise and highly suspected central spinal stenosis. Further evaluation with an MRI is recommended considering patient's provided clinical data of neck pain. 