34 years, Male, uncontrolled HIV/AIDS with HIV retinitis and new lesion on CT head. There is a peripherally enhancing lesion involving the right posterior aspect of the right inferior temporal gyrus near the occipital lobe junction with associated T1 hyperintensity and susceptibility indicative of subacute hemorrhage. There is central restricted diffusion which may represent pus. There is mild surrounding edema. The enhancing lesion measures approximately 24 x 8 mm in the axial plane and up to 18 mm in the craniocaudal dimension. Elsewhere in the brain there are multiple scattered linear foci of FLAIR hyperintensity involving the sulci with associated leptomeningeal enhancement. Again seen is prominence of the CSF space involving the posterior fossa which may be related to an arachnoid cyst or mega cisterna magna, without significant mass effect.Additional foci of T2/FLAIR hyperintensity in the bilateral frontal lobes were present previously and are nonspecific. There is no evidence of significant intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. There is moderate chronic mucosal thickening involving the right maxillary sinus and to a milder degree in the right frontal and anterior ethmoid sinus. There is a small left maxillary mucus retention cyst. These findings are similar to prior although the right frontal sinus opacification is improved since 7/30/2015. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.
1. Multifocal areas of leptomeningeal enhancement and nonsuppression of CSF on the FLAIR sequence in the bilateral cerebral hemispheres are most compatible with meningitis. There is a hemorrhagic lesion involving the right posterior temporal lobe near the occipital junction with enhancement, central restricted diffusion, and mild surrounding edema. This lesion is strongly favored to represent an abscess, although late subacute hemorrhage by itself may also have this appearance as well. No significant associated mass effect. Pyogenic infection as well as atypical organisms are in the differential. 2. Chronic paranasal sinus disease primarily involving the right maxillary sinus. Right frontal sinus opacification is improved since 7/30/2015.