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Very extensive lymph node enlargement is demonstrated on the right, involving the jugular chain, the posterior triangle, supraclavicular fossa, as well as thin intra-parotid nodes in the tail of the parotid (with evidence of local extranodal spread). Abnormal enlargement also seen in the retropharyngeal space extending towards the left, and multiple enlarged left jugular chain nodes are also present in.
In the superficial parotid, superiorly, just below the level of the external acoustic meatus has an enhancing nodule measuring 10 mm. The gland is enlarged and demonstrates heterogeneous enhancement posteriorly, extending to involve the deep lobe, and extending through the skull mandibular interval which is widened.
There is no evidence of direct extension into the muscles of mastication of the parapharyngeal space. No convincing enhancement of the facial nerve is identified. Although there is some slight asymmetry in signal on the coronal post-contrast images, this asymmetry is not evident in other planes or other sequences. Similarly the trigeminal nerve, Meckel's cave and cavernous sinus appear unremarkable.
The posterior fossa, and cervical canal appeared unremarkable (limited views)
Very extensive nodal disease predominately on the right, but also crossing the midline and in the retropharyngeal space, with abnormally enhancing right parotid gland involving both superficial and deep to without convincing evidence of perineural spread.