Suspicious Post-Surgical Changes in Patient with Undisclosed Cancer History

A 51-year-old male was referred for orthodontic and TMJ evaluation without significant medical history disclosed. The radiologist identified large post-surgical defects involving the sphenoid sinuses, nasal cavity, nasopharynx, and clivus, along with altered appearance of the left occipital condyle and an asymmetric polypoidal entity in the nasopharynx at the borders of the surgical defect. The radiologist contacted the referring practice, which then confirmed the patient had a history of clivus chordoma removal that had not initially been disclosed. Given the atypical changes near the post-surgical site and the history of cancer, the radiologist referred the patient back to the treating physician for further imaging to rule out residual disease or recurrence.