Diplopia. MG versus TED No appreciable orbital proptosis by imaging or enlargement of the extraocular muscles to suggest thyroid associated ophthalmopathy. Bilateral orbits appear within normal limits without evidence of mass or abnormal enhancement. Bilateral globes are intact. No abnormal signal within the optic nerves. There is artifact related to dental hardware which particularly degrades the diffusion and susceptibility weighted sequences. Within this limitation, there is no evidence of acute ischemia or acute hemorrhage. No intracranial mass or mass effect. There are multiple scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, similar to prior study, and compatible with mild chronic small vessel ischemic changes. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. No abnormal parenchymal or meningeal enhancement.Partially imaged is a circumscribed, lobulated, enhancing mass involving the left medial aspect of the parotid gland measuring approximately 2.2 x 2.9 cm in the transverse and craniocaudal dimensions, previously approximately 1.3 x 2.1 cm, measured similarly on 9/11/2010.
1. Bilateral orbits appear within normal limits. No imaging findings to suggest thyroid associated orbitopathy. 2. Mild chronic small vessel ischemic changes are again seen. Brain parenchyma appears otherwise within normal limits.3. Partially imaged is a lobulated, enhancing mass involving the medial aspect of the left parotid gland measuring approximately 2.2 x 2.9 cm in the transverse and craniocaudal dimensions. Finding is suspicious for neoplasm. Consider dedicated neck imaging and ENT consultation.Dr. Ali discussed with Dr. Qayum at 1550 hrs on 3/24/2015.