28-year-old male with history of von Hippel-Lindau. History laminectomy for spinal hemangioblastoma. Has current cerebellar/spinal hemangioblastomas. Evaluate for growth and new lesions. BRAIN MRI: Compared to 1/3/2014, there is no significant change in size of left cerebellar enhancing lesion measuring 7 x 5 x 7 mm, previously measuring 6 x 5 x 7 mm. No evidence for restricted diffusion to suggest acute ischemia or infarction. The ventricles and sulci are symmetric and unremarkable. No hydrocephalus identified. No mass effect, midline shift, or basal cistern effacement. No intra-or extra-axial fluid collection identified. Proximal intracranial flow voids are identified.2 mm enhancing punctate lesion within the right posterior aspect of the medulla is better seen on the cervical spine MRI and unchanged (sagittal cervical postgad 8/15 and axial 3D postgad 8/80 series 4401). No other sites of abnormal intracranial enhancement identified. No evidence of gross endolymphatic sac abnormality.Orbital contents are unremarkable bilaterally. There is mild opacification of the anterior ethmoid air cells bilaterally, otherwise the paranasal sinuses and mastoid air cells are clear. MRI OF THE CERVICAL SPINE: There is mild straightening of the normal cervical lordosis. Laminectomies are identified from C3 to C6 and mild enhancement involving the posterior spinous paraspinous tissue consistent with postsurgical change. Unchanged linear enhancement along the posterior aspect of the cervical cord at the C4-C5 level which likely represents postsurgical change. Minimal T2 hyperintensity and possible minimal intramedullary enhancement within the cervical cord at the C4-C5 level is also unchanged.There is mild desiccation signal seen at C2 to C6 levels. No evidence of spinal stenoses or significant foraminal narrowing. No new or enlarging lesions are seen within the cervical cord.MRI OF THE THORACIC SPINE: The alignment and curvature of the thoracic spine are anatomic. There is preservation of the vertebral body heights. The intervertebral disks have normal signal intensity. The marrow signal is normal. No evidence of significant degenerative changes, disk herniation or spinal stenoses. The thoracic spinal cord is unremarkable. No evidence of pathological intradural or vertebral enhancement.The paraspinal soft tissues are unremarkable. Partially visualized intra-abdominal contents demonstrate multiple bilateral renal lesions. Some of these lesions are complex and indeterminate on this nontargeted examination. These are better seen on prior MR Abdomen Exam.MRI OF THE LUMBAR SPINE: The alignment and curvature of the lumbar spine are anatomic. There is preservation of the vertebral body heights. The intervertebral disks have normal signal intensity. The marrow signal is normal. There is no evidence of significant degenerative changes, disk herniation or spinal stenoses. The visualized distal spinal cord has normal signal intensity and morphology. The conus medullaris terminates at the inferior endplate level of T12. The cauda equina and filum terminale are unremarkable.No abnormal intradural or vertebral enhancement identified. The paraspinal soft tissues are within normal limits. The partially visualized intra-abdominal contents again demonstrates multiple complex and cystic renal lesions.
1. Compared to 1/3/2014, there is no significant change in small enhancing lesion involving the left posterior cerebellar hemisphere compatible with a hemangioblastoma. A second punctate lesion identified on the prior study along the right posterior aspect of the medulla is also unchanged. No new lesions or evidence of intracranial mass effect.2. Stable postoperative changes in the cervical spine. Linear enhancement along the posterior surface of the cord at C4-5 and minimal T2 hyperintensity and punctate enhancement within the cervical cord at C4-5 are all unchanged and compatible with postsurgical change. Comparison with preoperative MRI would be helpful. No new or enlarging lesions in the cervical, thoracic, or lumbar spine.3. Please refer to separate report for findings in the abdomen including enhancing renal lesions.