Clinical question: Based on the study. Signs and symptoms: Metastatic melanoma. Please measure. Enhanced CT of brain:The examination demonstrates no evidence of metastatic disease to the brain or leptomeninges.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. No abnormal enhancement. Calvarium is intact, limited view of the orbits are unremarkable, mastoid air cells and middle ear cavities are unremarkable.There is complete opacification of the left chamber of the splenic sinus. This is associated with subtle thinning of the bone at the level of planum sphenoidale on the left. This finding is best appreciated on axial bone density (series 5) image 10, coronal reformatted bone density (series 8036) image 46, sagittal reformatted bone density image 28 through 30. There are also minimal increased density of the contents of the left chamber of the sphenoid sinus. Although all of the above findings could represent long-standing chronic sinus disease the associated bony changes are concerning and further follow-up or dedicated MRI exam is recommended to exclude the less likely possibility of a small metastatic bony lesion.120 cc of Omnipaque 350 was administered for the study.
1.Negative enhanced CT of brain parenchyma and the leptomeninges.2.Complete opacification of the left chamber of the sphenoid sinus with some subtle bony thinning of planum sphenoidale which remotely could represent a bony metastatic disease considering provided clinical data. The findings could also represent changes related to long-standing chronic sinus disease or even a small fibrous dysplasia. Please see above comments for exact location of the lesion. Follow-up with an MRI is recommended.