Case of the Week

Following completion of radiation therapy (March 2014), PET/CT fused axial view (A) demonstrates an intensely hypermetabolic soft tissue lesion likely in the left retropharyngeal space, which is consistent with tumor recurrence. T1WI MRI axial view (B) confirms the necrotic retropharyngeal node without evidence of perineural spread. Following two salvage endoscopic resections (January and February 2015) of retropharyngeal tumor, PET/CT axial (C) and coronal (D) fused images reveal an intensely hypermetabolic tumor in the left sphenoid sinus, pterygopalatine fossa, orbital apex, and inferior orbital fissure, with perineural spread through the foramen rotundum and ovale into the cavernous sinus. T1WI axial (E) and coronal (F) views confirm the perineural spread along V2 and V3 into the cavernous sinus.