There is a right sided lung lesion present adjacent to the paravertebral space at the level of the carina. MRI of the brainThere a several punctate foci of diffusion restriction along the left superior and middle frontal gyri.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This has progressed along the areas of diffusion restriction.The CSF spaces are appropriate for the patient's stated age with no midline shift. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The current exam was performed on a 1.5T magnet whereas the prior was performed on a 3T magnet. The distal internal carotid arteries and the proximal MCA are ACA arteries are less visualized on the current exam than on the prior. On the current exam the supraclinoid ICAs and ACA A1s appear smaller whereas the proximal MCA m1 segments are not readily visualized.There is prominent lenticulostriate vasculature presnt in the basal ganglia.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are identified. The vertebral arteries are similar in size.
1.Moya moya proximal intracranial anterior circulation vasculature narrowing appears to have progressed on this exam, however, this appearance may exaggerated by the use of lower field strength on the current exam.2.Several punctate foci of acute/subacute infarction are present in the left frontal lobe.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are likely vascular related. This has mildly progressed along the left frontal lobe compared to the prior exam along the areas of punctate infarctions.4.No significant intracranial hemorrhage is appreciated.