45-year-old male, history of altered mental status, evaluate for PTLD or CLL. Patchy increased T2 signal in the subcortical and periventricular white matter is nonspecific but likely related to treatment effect or and/or small vessel ischemic disease. There are no abnormal foci of enhancement, and there is no intracranial mass or mass effect. The ventricles are within normal limits in size and configuration. No evidence of acute ischemia or hemorrhage.Major flow-voids are present. The sella and orbits are grossly normal. Paranasal sinuses and mastoid cells are clear. Mild enhancement of the nasopharyngeal mucosa is noted and likely a sequela of treatment or mucositis. There is mild, diffuse enhancement of the calvarial marrow without a discrete focal lesion, which may be related to CLL.Prominent bilateral parotid lymph nodes are again noted with mild diffusion restriction. Additionally, there is a peripherally enhancing, 1 cm lesion which appears centrally cystic in the posterior left occipital soft tissues immediately posterior to the mastoid air cells (series 1101, image 42). This is favored to represent a necrotic lymph node. Infection remains a possibility but is less likely given lack of secondary associated findings including surrounding inflammation.
1.No intracranial mass, mass effect, or abnormal enhancement to suggest leukemia or PTLD in the brain.2.Nonspecific symmetrical cerebral white matter abnormality favored to be related to treatment effect or perhaps small vessel ischemic disease.3.Enlarged bilateral cervical and parotid lymph nodes. Additional 1 cm posterior left occipital soft tissue lesion likely represents a peripherally enhancing necrotic lymph node.