VHL. Evaluate for hemangioblastomas and ESLT. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. 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.Spine: There are multiple enhancing nodules along the cauda equina nerve roots, which appear to have increased in size. For example, the largest of these lesions situated at L1 now measures up to 16 mm, previously 11 mm in April 2014. There are prominent flow voids within the thoracolumbar spinal canal. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There are postoperative findings related to bilateral adrenalectomy. There are incompletely characterized subcentimeter nodules in the left retroperitoneal region and at the aortic bifurcation. There are bilateral renal cysts.
1. No evidence of intracranial mass lesions.2. Increase in size of multiple lesions within the lumbar spinal canal, which are compatible with hemangioblastomas.3. Incompletely characterized nodules in the left retroperitoneal region and at the aortic bifurcation, which may correspond to paragangliomas. Follow up via dedicated abdominal and pelvis imaging may be useful.