Clinical question: Patient with multiple myeloma, status post calibers stem cell transplant with relapsed disease. Signs and symptoms: Nausea and vomiting, central process suspected. Pre-and post-enhanced CT of brain:There is prominence of the supratentorial ventricular system when more apparent in the lateral ventricles and the third ventricle. There is also a paucity of cortical sulci. There is however no detectable cerebral edema and gray -- white matter differentiation is well-preserved. There are no old studies available for comparison. There is however partial visualization of the supratentorial ventricular system on prior CT of soft tissues of neck from 4 to 27 next 2010 which demonstrate similar sized ventricular system.There is no evidence of intracranial hemorrhage, edema or midline shift.Post infusion images demonstrate enhancement of thickened pituitary stalk that measures 6 mm in transaxial dimension. This finding was present on prior CT of soft tissues of neck from 4 -- 27 -- 2010.Examination also demonstrate thickening and enhancement along the left petroclinoid ligament which appears to be continuous with the enhancement of the cavernous sinus. There is no definitive associated bony changes however the dorsum sella on the left side and including the left posterior clinoid appear thinner than the right which may indicate erosive bony changes. The constellation of above findings could represent a metastatic disease or an infectious/granulomatous process. It is highly recommended that this finding to be followed with an enhanced MRI of pituitary and brain which would visualizes all the above regions of abnormal finding.Bony density of calvarial demonstrate multiple well demarcated small lytic lesions within the diploic space. Considering patient's history of multiple myeloma this finding may represent multiple myeloma. MRI examination with further clarified this finding.Above findings were discussed with the referring clinical service Garcia Ima pager number 5251 at the time of interpretation.80 cc of Omnipaque 350 was administered for this study.
1.Abnormal enhancement of the left cavernous sinus with extension posteriorly along the petroclinoid ligament and left CP angle. Thickened pituitary stalk with enhancement and with possible some thinning of dorsum sella as described above. Follow-up exam with an MRI is recommended. The constellation of above findings can be secondary to a metastatic disease, infectious or a granulomatous process.2.No definitive evidence of parenchymal abnormality of brain.3.Prominent lateral ventricles with only minimal dietitian of temporal horns. This finding may be a normal variation which was also partially visualized on prior CT of soft tissues of neck from 4 -- 27 -- 2010. This finding is not associated with any periventricular edema and I believe this is a normal anatomical variation for patient's age. Follow-up MRI would further assess this finding.4.Multiple well demarcated lytic lesions of calvarial with the largest measuring only 6 mm times 5-mm in the right frontal bone. Findings may also represent multiple myeloma.5.Above findings were discussed with referring clinical service Garcia Ima pager number 5251.