Diagnosis: Acute lymphoblastic leukemia not having achieved remission Unspecified mycosisClinical question: disseminated fungal infection in brainSigns and Symptoms: fungal stain positive, pulm nodules The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus.. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.There is diffuse marrow replacement present in the visualized calvarium, skull base and C1 and C2 vertebrae.
1.Diffuse marrow replacement is compatible with patient's clinical diagnosis of a lymphoblastic leukemia.2.No intracranial mass lesions are appreciated to suggest a fungal infection to the brain at this time. There is also no evidence for brain metastases appreciated.