Fatigue and diarrhea. Found to have CMV viremia, C. Difficile colitis and CNS nocardia. Repeat imaging due to immunocompromise status per transplant cardiology. There is an enhancing lesion within the splenium of the corpus callosum measuring 1.8 x 1.6 x 2.4 cm, unchanged. Within the corpus callosum, adjacent to this lesion, there is restricted diffusion, also unchanged. There is adjacent T2 hyperintensity extending into the periventricular white matter of the occipital horns of the lateral ventricles. There is ill-defined enhancement within the right superior aspect of the pons, unchanged from prior. There are multiple foci of T2 hyperintensity within the subcortical and periventricular white matter, which are nonspecific but probably secondary to chronic microvascular ischemic disease. There are multiple foci of susceptibility within the bilateral cerebral hemispheres consistent with microhemorrhages, which are unchanged since the prior study. An empty sella is incidentally noted. There is sulcal and ventricular prominence, compatible with mild generalized parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.An enhancing lesion within the splenium of the corpus callosum is unchanged in size, with adjacent restricted diffusion within the corpus callosum and periventricular vasogenic edema.2.Unchanged periventricular and subcortical T2 hyperintensities, compatible with mild to moderate microvascular ischemic disease.