55 years Male (DOB:11/6/1960)Reason: evaluate likely TB abscesses, interval change History: see abovePROVIDER/ATTENDING NAME: KAMALA GULLAPALLI COTTS KAMALA GULLAPALLI COTTS A previously noted ring-enhancing lesion along the right centrum semiovale hasn't changed in appearance and size. It now measures 6 mm in diameter where as previously measured 11 mm and enhances homogeneously rather than any ringlike pattern. The degree of facet associated surrounding T2 and FLAIR signal hyperintensity is decreased relative to the previous exam. Diffusion restriction is no longer present within the center of this lesion.A previously noted right cerebellar ring-enhancing lesion has also changed in appearance. It is also now more confluent enhancement, however, is associated with a couple satellite lesions and slightly more T2 and FLAIR signal hyperintensity adjacent to it. Diffusion restriction is no longer present within the center of this lesion.Since prior exams ependymal enhancement along the occipital horn and trigone of the right lateral ventricle has thickened and is associated with narrowing of the occipital horn and trigone of the right lateral ventricle. There is an additional focus of enhancement now present along the temporal horn of the right lateral ventricle. Vasogenic edema surrounding the trigone and occipital horn of the right lateral ventricle has increased. There is significantly less diffusion restriction within the right lateral ventricle on the current exam versus the prior exam. This diffusion restriction involves the tip of the occipital horn of the right lateral ventricle and is not present in the frontal horn on the body of the right lateral ventricle or the trigone of the right lateral ventricle as it was on prior exams.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam a ring-enhancing lesion in the right centrum semiovale has decreased in size and has evolved. The patient is known to have tuberculosis.2.Since the prior exam right lateral ventricle ependymal enhancement compatible with ventriculitis and thickening has progressed and is associated with a greater inflammatory reaction on the current exam relative to the prior. 3.Since the prior exam a right cerebellar lesion known to represent tuberculous abscess has also evolved. It now has a couple satellite lesions but overall has slightly increased in extent/inflammatory reaction on imaging.