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CT SCAN CHEST:   Routine CT scan of the chest is performed showing what appears to be a small 1 cm lymph node between the left common carotid artery and left subclavian artery which is probably not pathologic. No other mediastinal adenopathy is identified. The pleural surfaces and lung parenchyma are unremarkable for nodularity. The liver is a also unremarkable. CT SCAN NECK AND CHEST:   Multiple sequences of the neck and chest are obtained showing several large masses in the right neck in the parapharyngeal and paratracheal space, the largest approximately 4 cm in diameter. These masses are on both sides of the neck and extend into the superior mediastinum with somewhat bulky adenopathy in this area. The large mass extends into the superior mediastinum as well. These masses are moderately homogeneous with increased signal consistent with tumor.

IMPRESSION:   Extensive masses in the low neck and superior mediastinum bilaterally, right greater than left. Malignancy is highly suspected. HISTORY:  Pain in the fingers.

RIGHT FINGERS:   Two views were obtained showing a soft tissue mass at the radial aspect of the distal index finger at the distal interphalangeal joint with erosion of the distal phalanx suggestive of gouty tophus in that region.

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