Left sided facial swelling. Assess for infection. Brain MRI:There is no acute infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. There is no mass or abnormal intracranial contrast enhancement. There is no extra-axial fluid collection. The major intracranial vascular flow voids are preserved.Mastoid air cells are clear. A well-circumscribed T2-hyperintense, contrast-enhancing lesion, measuring up to 1.5 cm, involving the right parietal bone may represent an incidental hemangioma.Orbits MRI:There is thickening and infiltrative T2-hyperintense signal involving the left cheek area extending medially to the left nasal side wall without drainable fluid collection. There is no or very minimal involvement of the left preseptal/preorbital tissue. The orbits are unremarkable accounting for the chronic right inferior orbital blowout fracture with associated fat herniation and apparent tethering of the inferior rectus muscle.Moderate mucosal thickening in the inferior aspect of the left maxillary sinus has not changed since previous CT scan. This is associated with inflammatory changes involving the left premaxillary and retromaxillary fat along with periosteal contrast enhancement which correlates with periosteitis on the previous CT scan. Adjacent periodontal disease involving teeth #15 and 16 is better assessed on the CT scan. The mild mucosal thickening and opacification in the ethmoid sinuses is unchanged. Cranial MRV:The dural venous sinuses are patent as well as the internal cerebral veins. There is also no cortical vein thrombosis. There is no definite thrombosis of the cavernous sinuses, which are fairly symmetric.
1.Left facial soft tissue inflammatory/infectious changes without drainable fluid collection are probably related to underlying left chronic maxillary sinusitis, which in turn is probably odontogenic given the adjacent periodontal disease (teeth #16 and 15), which is better assessed on the CT scan.2.Chronic right orbital floor blowout fracture. No other post septal orbital abnormality.3.No dural venous thrombosis.