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Neck CT with contrast: Routine transverse CT images through the neck after the IV administration of nonionic contrast with coronal and sagittal reformations.

Findings: There are multiple necrotic enlarged lymph nodes most prominent in the left level Ib and level IIa neck. There is a level Ib centrally necrotic peripherally enhancing heterogenous lymph node measuring 2.2 x 1.5 cm. Necrotic left jugulodigastric lymph node and small necrotic left level 3 lymph node is also identified. Multiple additional smaller left-sided level for lymph nodes are noted, not pathologically enlarged by size criteria have a rounded configuration and enhancement within expected. A right-sided round lymph node measures 9 mm in short axis diameter and has loss the normal fatty hilum. Contralateral disease cannot be excluded. There is fatty infiltration surrounding the left level Ib lymph nodes suspicious for extracapsular spread of disease. Inflammation extends into the platysma muscle and subcutaneous fat of the left neck.

There is mild asymmetry of the tongue base however no definite mass lesion is identified within the pharyngeal mucosal space. The vocal cords are symmetric bilaterally. No laryngeal mass lesion is identified.

Lung apices are clear. Thoracic inlet structures demonstrate no significant abnormality.

Skull base foramina are unremarkable. Minimal polypoid mucosal thickening is noted in the right maxillary sinus. Mild multilevel degenerative changes are noted in the spine.

Multiple necrotic lymph nodes predominantly involving the left level I and II neck. A small, subcentimeter but necrotic lymph node in the left level 3 neck is also noted. There is likely extracapsular spread involving the left level Ib lymph nodes. These findings are suspicious for metastatic disease from a squamous cell malignancy however tuberculous infection, fungal disease or other forms of lymphadenitis could have a similar appearance. ENT consultation and tissue sampling is suggested.
B (13162082)