ESRD status post renal transplant in 2005 who presents with PTLD in the CNS. There are postoperative findings related to left transfrontal biopsy. There is unchanged confluent T2 hyperintensity and susceptibility effect in the superior left frontal lobe without associated mass effect. There is also unchanged scattered cerebral white matter T2 hyperintensity, particularly in a periventricular distribution. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged, including a left occipital scalp lipoma.
Unchanged areas of cerebral white matter signal abnormality that may represent treatment effects that are perhaps superimposed upon mild chronic small vessel ischemic disease, without evidence of recurrent PTLD, although the assessment is limited due to the lack of intravenous contrast.