21 year old male with a diagnosis of Von Hippel-Lindau disease; history of 6 small asymptomatic brain hemangioblastomas, evaluate for growth and new lesions. BrainAgain visible are changes of a prior suboccipital craniotomy. There are at least three new suspicious areas of nodularity compared to the prior exam, although there was extensive motion degradation on the prior exam, limiting direct comparison. Just medial to a previously seen lesion in the right paramedian cerebellum is a smaller lesion which is now more conspicuous and not definitively present prior to Jan 2015 (series 4500, image 52). An additional new punctate left mid-superior cerebellar lesion is seen (series 4500, image 54). Finally there is suspicion of a new punctate left medial superior cerebellar peduncle lesion (series 4500, image 53).The enhancing nodule along the midline dorsal medulla at the level of the foramen magnum, measures 6 x 6 mm and is unchanged in size compared to the prior exam but has had a gradual increase in size since the baseline exam from 9/10/2012. The additional previously described small enhancing nodules in the bilateral cerebellar hemispheres are again seen. No lesions within the supratentorial brain are appreciated. No evidence of acute ischemia or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Interval development of diffuse paranasal sinus mucosal thickening and opacification most prominently involving the bilateral maxillary and sphenoid sinuses as well as the ethmoid air cells. There is mild mucosal thickening involving the frontal sinuses and scattered mastoid air cell opacities bilaterally. The calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Redemonstration of an intramedullary lesion in the posterior cervical cord at the C4 level which measures 9 mm in maximum dimension and is not significantly changed. There is equivocal slight cranial extent of the surrounding upper cervical spine STIR hyperintense edema, on axial images more along the right aspect of the central cord. Otherwise, the edema pattern is not significantly changed.The vertebral body and intervertebral disc heights are maintained. Straightening of the cervical lordosis is seen, alignment is otherwise maintained. No suspicious bone marrow signal abnormalities. No new cervical cord lesion. No disc bulges, neural foraminal stenosis, or spinal canal stenoses in the cervical spine. Thoracic spine:Redemonstrated are enhancing lesions in the right posterior cord at the T4 level measures 7 mm, unchanged. An additional lesion in the right posterior cord at the T6 level measures 6 mm, and is unchanged on re-measurement compared to the prior exam. These lesions are associated with mild cord edema appearing similar to prior.There is stable mild straightening of the thoracic spine. Mild endplate irregularity which was also previously present from T9 through L1 with mild wedging deformities of the T10 and 11 vertebral bodies are unchanged. No evidence of acute fracture. There is no significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing. Lumbar Spine:The lumbar spine alignment is anatomic, and the vertebral body and intravertebral disc heights are maintained. No bone marrow signal abnormalities. No enhancing masses are noted in the conus or cauda equina. There is no significant disc bulge, spinal canal stenosis, or neuroforaminal narrowing. The paraspinal soft tissues and partially visible intra-abdominal contents are unremarkable.
1.At least three new suspicious areas of nodularity in the cerebellum compared to the prior exam, although note that the prior exam was limited by motion.2.Dorsal medullary nodule stable from recent comparisons although progressed since baseline exam.3.The additional previously characterized enhancing lesions in the bilateral cerebellar hemispheres, cervical spinal cord, and thoracic spinal cord are unchanged.4.There is equivocal slight cranial extension of the upper cervical spinal cord edema more along the right aspect of the cord, versus artifact, which would warrant close attention on follow up exams. The remainder of the edema pattern in the cerebellum and elsewhere in the spine is stable.5.Findings indicating acute pan-sinusitis, new since the prior exam. Please correlate clinically.