87 years Female (DOB:12/1/1928)Reason: 87 year old female with metastatic breast CA (to skin) with worsening painless, enophthalmos and restricted motility of right > left eye for last 6 months. History: 87 year old female with metastatic breast CA (to skin) with worsening painless, enophthalmos and restricted motility of right > left eye for last 6 monthsPROVIDER/ATTENDING NAME: SUSAN M KSIAZEK SUSAN M KSIAZEK MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate T2 and FLAIR signal hyperintense lesions are also present in the internal capsules and brainstem.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an air-fluid level in the left maxillary sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.There is a mild thickening of the alar ligaments redemonstrated at C1-2.MRI orbits:The eyeballs are intact. There is redemonstration of enhancement within the intraconal space bilaterally but more prominent than the right relative to the left side. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .There is some mild enhancement along the left temporalis muscle which was also present on the prior exam but is less prominent on the current exam. To a lesser degree there is minor enhancement along the right temporalis muscle. This is also less than on the prior exam.
1.There is enhancement of the intraorbital fat bilaterally but more so on the right than the left side. This was also present on the prior exam. This appearance has not changed substantially. No intraorbital mass is appreciated. Differential considerations include an infiltrative neoplasm versus an inflammatory process. 2.Associated with the orbital infiltrative lesions other is some mild enhancement along the left temporalis muscle which was also present on the prior exam but is less prominent on the current exam. To a lesser degree there is a minor enhancement along the right temporalis muscle which could also be part of the same process. This is also less than on the prior exam.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.4.Punctate lesions in the internal capsules and brainstem are likely vascular related as well 5.There is an air-fluid level in the left maxillary sinus raising the question of acute sinusitis.6.There is redemonstration of some signal hyperintensity in the left temporalis muscle which appears to have regressed relative to the prior exam.7.There is no convincing evidence for brain metastases.