Clinical question: 83-year-old female with myelofibrosis with neutropenia and altered mental status and congestion. Signs and symptoms: Neutropenia Nonenhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is within normal for patient stated age of 83. Limited view of orbits are unremarkable. Calvarium demonstrates old biparietal burr holes and is otherwise unremarkable. Limited view of paranasal sinuses are unremarkable.Nonenhanced CT of paranasal sinuses:Routine nonenhanced CT of paranasal sinuses are obtained.The paranasal sinuses are well pneumatized and with no evidence of acute or chronic sinus disease. The frontal sinuses are not developed.Images through the nasal cavity are essentially unremarkable with the exception of a small septal bony spur projecting to the left and measuring 4-mm in size. Diffuse sclerotic changes of clivus without any bony destructive changes is noted. Please correlate with history and if clinical concern persist follow-up with an MRI is recommended.
1.Negative CT of brain .2.Negative CT of paranasal sinuses. Frontal sinuses are not pneumatized which is an anatomical variation.3.Diffuse sclerotic changes of clivus with no destructive bony changes. Correlate with history and follow-up with an MRI if there is a clinical concern for malignancy.