Pyriform fossa squamous cell carcinoma with necrotic nodal metastases
Left parotid swelling and cervical lymphadenopathy. PMHx haemodialysis, lung cancer, diabetes and ischaemic heart disease.
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Centred in the left hypopharyngeal mucosal space is a ill-defined slightly hypodense lesion medial to the carotid space and parapharyngeal space. It appears to be arising from the left aspect of the piriform fossa (hypopharynx).
It measures approximately 23 mm transversely and 24 mm caudocranial. Inferiorly there is para glottic extension however the pre-epiglottic fat is preserved. Posteriorly there is loss of fat plane between it and the prevertebral muscles. Medially there is loss of fat plane between it and the carotid artery. The carotid arteries are heavily calcified. The superior cornu of the thyroid cartilage is encased by tumour.
There are numerous left cervical enlarged lymph nodes deep to the left sternocleidomastoid muscle. At level IIa a conglomerate of nodes measures 35 x 20 mm, with some known necrotic peripheral components. At the border of level II and III is a pre-jugular 11 mm necrotic lymph node.
The right parotid gland is bulkier than the left however it maintains normal slightly heterogenous attenuation identical to the left side of gland. No focal lesion or intraparotid lymph node is identified in either parotid gland. The submandibular slightly glands are normal.
No acute bony abnormality.
Left piriform fossa tumour with extensive cervical necrotic lymphadenopathy.