History of ALL with neutropenic fever and fungal sinusitis presenting with headache. Evaluate for mass. Motion artifact and lack of intravenous contrast limits evaluation. There is no evidence of acute intraparenchymal hemorrhage, mass effect, or acute infarct. There is minimal extra-axial fluid along the bifrontal convexities which does not suppress on the FLAIR sequence raising possibility of subdural collection versus prominent subarachnoid space with artifact. No hydrocephalus. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is diffuse mucosal thickening of the paranasal sinuses, which is new compared to CT of 4/20/2015. Subtle T2/FLAIR hyperintense signal in the left periorbital soft tissues and retrobulbar fat is nonspecific. Subtle extension into the orbits is incompletely evaluated on this motion degraded and noncontrast study. There is partial opacification of the bilateral mastoid air cells.
1.Limited evaluation due to motion artifact and lack of intravenous contrast. No evidence of acute intraparenchymal hemorrhage, mass effect, or acute infarct. 2.Interval development of diffuse mucosal thickening of the paranasal sinuses, compared to CT dated 4/20/2015. There is possible abnormal FLAIR signal within the left orbit along the left medial orbital wall. There is also small extra-axial collection along the bilateral frontal convexities which is seen on the FLAIR sequence. Invasive fungal sinusitis with left orbital extension and possible intracranial extension cannot be excluded. Recommend performing MRI of brain with gadolinium and MRI of sinuses with gadolinium under sedation. Alternatively, maxillofacial CT with contrast can be considered.3.Nonspecific partial opacification of the bilateral mastoid air cells. Findings discussed with Dr. Watson on 5/3/2015 at 11:15 AM.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.