Clinical question: New tiny a lesion on MRI. Concern for arteriovenous malformation. Evaluate for arteriovenous malformation. Signs and symptoms: Neck pain/stiffness/headaches. Non-enhanced CT of brain:Examination demonstrate no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Previously noted mildly enhancing cranial mass is not identified on this exam. There was no evidence of arteriovenous malformation malformation on prior MRI exam or the current CT.Calvarium is intact.Mastoid air cells, middle ear cavities and limited view of the paranasal sinuses are within normal.CTA of intracranial circulation:Right internal carotid is well visualized across the skull base and through the cavernous sinus with no abnormality. Supraclinoid right internal carotid artery, right posterior communicating artery, right anterior and middle cerebral arteries and their branches are within normal limits.Left internal carotid is well visualized and unremarkable in its cavernous and supraclinoid portion. There is normal visualization of a small posterior communicating artery. The anterior and middle cerebral arteries are within normal limits. There is anatomical variation of hypoplastic left A1. There is no evidence of arteriovenous malformation.Vertebral basilar system, there is normal visualization of bilateral intracranial vertebral arteries. Normal appearing right pica is identified. There is no visualization of the left pica. Basilar artery, superior cerebellar arteries and posterior cerebral arteries are well visualized and within normal limits. There is no detectable arteriovenous malformation as clinically questioned. The findings in the pineal region noted on prior MRI is not consistent with an arteriovenous malformation and it represents a mass.65 cc of Omnipaque 350 is administered for above study.
1.Negative non-enhanced CT of brain. 2.Previously noted less than one CM mass in the pineal region is not identified on this non-infused head CT.3.No evidence of arteriovenous malformation on this CTA or prior MRI exam.4.Negative CTA of intracranial circulation.