Diagnosis: Headache(784.0)Clinical question: r/o structural abnormalitySigns and Symptoms: headacheComments: S/p left parotidectomy | The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the 9/7/2012 examNormal 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.The left parotid gland is smaller than the right parotid gland - probably related to the reported history of parotidectomyThere is redemonstration of a cystic lesion in the superficial portion of the left parotid gland. It is homogeneously hyperintense in signal on T2-weighted imaging, intermediate signal on FLAIR imaging hyperintense on ADC map, hypointense on exponential ADC map, mildly hyperintense on diffusion imaging and hypointense on T1-weighted imaging. It measures 14 x 12 mm axial dimensions. On the prior exam it measured approximately 8 x 10 mm .There is now a similar lesion in the right parotid gland measuring 11 x 9 mm axial dimensions which was not present on the prior exam. It is adjacent and superficial to the right retromandibular vein. Along the posterior superficial aspect of the right parotid gland there is an incompletely visualized 10 x 6 mm similar lesion which previously measured 7 x 3 mm.
1.Continued enlargement of a left parotid gland lesion. In general this has a relatively benign appearance.2.New right parotid gland lesion which has similar signal characteristics and morphology to the left-sided parotid lesion but is smaller. It is adjacent and superficial to the right retromandibular vein.3.A smaller right parotid gland cystic type lesion along the posterior superficial portion has also mildly increased in size compared to the previous exam from 2012.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. These are stable compared to the 2012 exam.