Female, 45 years old, with acute lymphoblastic leukemia, presenting with a right visual field change involving the left eye. Assess for leptomeningeal disease as well as for hemorrhage. Brain:Amorphous abnormal signal is evident within the left globe, primarily situated along the central and temporal margins of the posterior globe with some additional strands which extend anteriorly to the lens. This material demonstrates strong susceptibility artifact highly suggestive of hemorrhage. This blood product may be both subretinal and within the vitreous. As such, detachment of the retina should be suspected. There is mild enhancement of the underlying choroidal layer.No evidence of any significant brain parenchymal signal abnormality is seen. No mass effect or edema is detected. No pathologic parenchymal or leptomeningeal enhancement is seen. The ventricles are normal in size and morphology. No abnormal extra-axial fluid collections are observed.Spine:Spinal cord morphology and signal characteristics are within normal limits. No pathologic intramedullary or leptomeningeal enhancement is seen. Likewise, the nerve roots of cauda equina are of normal caliber and free of pathologic enhancement. No epidural pathology is suspected.Spinal alignment is anatomic. Vertebral body heights are preserved. Bone marrow signal characteristics demonstrate diffuse and mild low signal on the T1-weighted images which likely indicates marrow reconversion related to anemia or chronic disease. No evidence of marrow edema or suspicious marrow replacement is seen.At C5-6, there is mild disc osteophyte formation with a very mild spinal canal stenosis but no significant foraminal narrowing. Small disc protrusions are seen at T2-3 and T12-L1 without significant spinal canal or foraminal stenosis.At L5-S1, there is a small central disc protrusion, without significant spinal canal or neuroforaminal stenosis.
1.Left intraocular hemorrhage is seen, along the posterior and left temporal margin of the globe, which may be both subretinal and within the vitreous. The choroidal layer underlying the area of hemorrhage is mildly enhancing. The possibility of retinal detachment should be considered. In addition, given the clinical history, the possibility of intraocular leukemic involvement should be considered.2.Otherwise, unremarkable evaluation of the brain. In particular there is no evidence of intracranial leptomeningeal disease.3.Likewise, evaluation of the spine shows no evidence of leptomeningeal disease. Mild degenerative findings are noted as above.