Followup of CNS toxoplasmosis: fever/weight loss. PER EPIC: "ESRD 2/2 HTN now s/p kidney transplant in 2009,on immunosuppressive therapy, CKD, HTN, PUD, mild LV diastolic dysfunction and myopic degeneration." There is slight interval decrease in size of ovoid lesions with restricted diffusion in the right occipital lobe and associated vasogenic edema. There is also substantial decrease in size of lesions with surrounding vasogenic edema in the right frontal corona radiata, left periatrial white matter, and left superior frontal gyrus and paracentral lobule. There is increased susceptibility effect associated with the right corona radiata and posterior right occipital lobe lesions. There is otherwise an unchanged background of nonspecific punctate foci of cerebral white matter T2 hyperintensity. The ventricles are unchanged in size. There is no midline shift or herniation. The major cerebral flow voids are intact. There is staphylomatous deformity of the bilateral globes and a left orbital implant. The mastoid air cells, skull, and scalp soft tissues are grossly unremarkable. There is a lobulated lesion in the left nasal cavity and ethmoid sinuses with low T1 and T2 signal. There is otherwise scattered mild paranasal sinus mucosal thickening.
1. Overall interval decrease in size of the multifocal brain lesions with associated vasogenic edema likely related to an infectious process, in which some have decreased more dramatically than others. However, increased susceptibility effect associated with the right corona radiata and posterior right occipital lobe lesions may represent hemorrhage. Assessment is otherwise limited due to the lack of intravenous contrast, acknowledging the ESRD contraindication.2. Material within the left nasal cavity and ethmoid sinuses may represent chronic secretions or perhaps a neoplasm. Endoscopy may be useful for further evaluation.3. Bilateral elongation of the globes related to myopia.