Aneurysm of unspecified site [442.9], Reason for Study: ^Reason: h/o ophthalmic aneurysm; need to visualize carotid bifurcation in preparation for clipping History: preop planning Neck MRI:Multinodular thyroid mass on bilateral lobes and isthmus with inhomogeneous enhancement indicating multinodular goiter. Detailed imaging characteristics and extent might need ultrasound examination and if necessary fine needle biopsy.There is no sizable neck lymphadenopathy.The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patentLimited coverage of the brain shows linear tissue defects on the left thalamus indicating prior hemorrhagic stroke.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. Bilateral common carotid arteries were laterally displaced due to large thyroid goiter and the bifurcation of right CCA is around C23 level and that of the left side is mid C3 vertebral body level.The proximal cervical segment of bilateral ICAs are located retropharyngeal space but from the level of C12, they are within carotid space. About 7mm x 11mm sized right para-ophthalmic aneurysm and 5mm x 6mm sized left para-ophthalmic aneurysm are seen, no significant interval change since prior scan.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Multinodular goiter as described above.2. No change of the size and configuration of bilateral paraophthalmic aneurysms.3. The right carotid bifurcation is around C23 level and that of the left is around mid C3 level.4. Post hemorrhagic stroke tissue defect on the left thalamus. 