Male, 19 years old, history of von Hippel-Lindau, history of brain hemangioblastoma status post resection. Assess for hemangioblastomas and endolymphatic sac tumor. Image quality is degraded by motion artifact. Given this limitation, the following observations are made.Brain/IAC:Evidence of prior midline approach suboccipital surgery is demonstrated. A 5-mm nodule of enhancement is evident along the dorsal surface of the medulla at the level of the foramen magnum. This lesion is associated with mild edema.Elsewhere in the cerebellum, at least 5 small enhancing lesions are demonstrated (see key images) ranging in size from punctate up to about 3 mm in diameter. Mild edema is associated with some of these lesions.Dedicated imaging of the temporal bones and inner ear structures shows no evidence of any enhancing or destructive mass to suggest the presence of an endolymphatic sac tumor.No definite supratentorial lesions are seen. No evidence of significant mass effect is demonstrated. No abnormal fluid collections or acute intracranial hemorrhage is detected. Ventricles are normal in size and morphology.Spine:An enhancing lesion is seen within the dorsal spinal cord at the C4 level measuring up to 6 mm in diameter. This lesion is associated with moderate cord edema.An enhancing lesion is demonstrated within the right posterior cord at the T4 level measuring up to 6 mm in diameter. Another lesion within the right posterior cord at the T6 level measures up to 5 mm in diameter. Both are associated with modest cord edema.No evidence of any additional spinal cord or cauda equina enhancing lesions is seen. No significant spinal canal stenosis is demonstrated.Small Schmorl's nodes are seen at T10 through L1 where there is a mild exaggeration of the thoracic kyphosis. The vertebral bodies are mildly wedged at this level as well. No pathologic marrow signal or evidence of marrow edema is seen. Mild subcutaneous enhancement of the posterior neck is nonspecific and of uncertain significance.
1. Multiple enhancing nodules are demonstrated within the cerebellum and along the dorsal surface of the medulla compatible with hemangioblastomas. These lesions are associated with mild edema. Evidence of prior surgery is seen within the posterior fossa. No supratentorial lesions are identified, including no evidence of endolymphatic sac tumor.2. Enhancing lesions are seen within the spinal cord at the C4, T4 and T6 levels compatible with hemangioblastomas. These are associated with mild cord edema. No disease is demonstrated in the lumbar region.3. Schmorl's nodes are seen at T10 through L1 were mild vertebral body wedging results in exaggeration of the thoracic kyphosis. Findings may represent incidental Scheuermann's disease.