 BRAIN: There is no acute infarct, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The extracranial soft tissues are grossly unremarkable. Osseous marrow signal is mildly heterogeneous with no detectable discrete lesion, although CT is more sensitive for lucent myelomatous osseous lesions.ORBITS: There is asymmetric right lateral periorbital soft tissue thickening including the skin surface with associated enhancement posterior hyperintensity. In addition, there is slight asymmetric thickening and enhancement of the right eyelid. The findings are seen in the right superolateral extraconal space which appears to relate to the lacrimal gland, again with asymmetric enhancement. The adjacent bone is unremarkable.The globes and extraocular muscles are intact with normal signal intensity and caliber. The lens are not dislocated. The optic sheaths and optic nerves are within normal limits in caliber and signal intensity. There is no proptosis. There is an incidental partially empty sella. There is no mass effect on the optic chiasm. The pituitary stalk is midline. The cavernous sinuses are symmetric in enhance normally. There is no enlargement of the superior ophthalmic veins.
1. Asymmetric enhancement, abnormal signal, with soft tissue prominence involving the right lacrimal gland and right periorbital soft tissues including the skin surface as well as superolateral extraconal space . This is nonspecific, although the differential diagnosis includes infectious/inflammatory etiologies such as sarcoid or Sjogren's, orbital pseudotumor, with malignancy felt to be less likely but not excluded including lymphoma or primary glandular tumor. Myelomatous involvement of the lacrimal gland is rare although has been reported.2. No intracranial abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.