25 years Female (DOB:12/26/1991)Reason: seizure workup and r/o tumor History: seizure workupPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI There is right-sided dural thickening associated with some leptomeningeal enhancement. Adjacent to the temporal lobe, thickness of the dura is up to 9 mm. There is associated enhancement and opacification of the mastoid air cells bilaterally as well as the right sphenoid bone including foramen ovale. Looking at the recent head CT there is some associated bone erosion. There is an enhancing lesion present along the right masticator space, right parapharyngeal space, which involves the medial pterygoid muscle as and to a lesser degree the right lateral pterygoid muscle and right pharyngeal mucosal space. Additionally there is FLAIR signal hyperintensity present within the right inferior parietal lobule.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 opacified. The visualized portions of the orbits are intact.
1.There is right sided pachymeningeal and leptomeningeal enhancement present associated with contiguous infiltrative involvement of the right masticator space, right parapharyngeal space, right nasopharyngeal mucosa, right mastoid air cells, adjacent right calvarium and right sphenoid bone. Looking at the recent head CT there is some associated bone erosion. There is additional involvement of the right inferior parietal lobule. Differential considerations include lymphoma, sarcoid, granulomatous disorder, as well as infection including TB and fungal infection. 2.There is a left-sided mastoid air cell single lesion similar to the right-sided mastoid air cell enhancement without the extraosseous extensions. Looking at the recent head CT there is some associated bone erosion.An email was sent to Dr Mastrianni and am alphanumeric text was sent to Dr ALSHAIKH, JUMANA at the time of this dictation.