Female, 41 days old, ex 34 week gestation, with multiple facial and cranial dysmorphic features, history of congenital HIV infection, with multiple anomalies identified on prenatal imaging including incracranial mass or hemorrhage. Brain:The space occupying process seen on prenatal imaging which was situated posterior to the right thalamus has resolved. In its place, there is susceptibility effect compatible with hemosiderin staining which lines the right transverse cerebral and choroidal fissures and the ambient cistern. Foci of susceptibility effect are also seen within the occipital horns and along the fourth ventricular margins likely indicating additional sites of hemosiderin staining.No evidence of acute intracranial hemorrhage is seen, including in the areas of the germinal matrix. No restricted diffusion, edema, mass or mass effect is identified. No pathologic intracranial enhancement is observed. The ventricles are normal in size and morphology. The pituitary region is within normal limits. The corpus callosum is fully formed and intact. The brainstem and cerebellum are likewise within normal limits. The pattern of white matter myelination is appropriate or at most minimally delayed for the corrected gestational age. The degree of sulcation and overall cerebral morphology are within normal limits. No migrational anomalies are detected.Orbits:Right sided findings:The right orbit is smaller than the left. A rudimentary or atrophic and malformed globe is suspected inferiorly within the orbit. Some orbital adnexae are present though they are dysmorphic and not well delineated. A hypoplastic or atrophic right optic nerve is seen.Left-sided findings:The globe is slightly elongated in the AP dimension. A lens or lens-like structure does appear to be present though it is small and situated more anteriorly than typical. A small focal outpouching of the globe along the inferior surface may represent a coloboma (see image 3series 901). The optic nerve is visualized. The extraocular muscles are present but precise delineation is difficult.Neck:The neck soft tissues are within normal limits. No cystic or solid masslike lesions are seen. The airway is patent. Bone marrow signal intensity is within normal limits. Irregularity of the left aspect of the nose is seen and can be correlated with physical exam findings.
1.On comparison with fetal imaging, a space occupying process posterior to the right thalamus has resolved leaving behind an area of cisternal hemosiderin staining. This lesion likely represented an extra-axial hematoma or hemorrhagic cyst. Trace hemosiderin staining is evident in the ventricular system. No findings to suggest acute intracranial hemorrhage are observed.2.Cerebral and cerebellar morphology are otherwise within normal limits. No parenchymal defects, encephalomalacia or migrational anomalies are observed. The degree of gyral development is appropriate for age. No findings to suggest active intracranial infection are demonstrated.3.The right orbit is small and the globe is severely atrophic or hypoplastic. A small right optic nerve seems to be present. On the left, the globe is mildly dysmorphic with a probable small inferior coloboma. The optic nerve is present on the left.4.Imaging of the neck soft tissues is within normal limits. Mild deformity of the nose can be better assessed on physical exam.