 Orbits: The right lacrimal gland is enlarged diffusely, with hyperenhancement. There is increased fluid signal adjacent to the right lacrimal gland, likely related to increased lacrimation. There is mild right posterolateral uveoscleral thickening and enhancement. In addition, there is inferotemporal low T2 and intermediate T1 signal material that appears to be subretinal and measures up to 5 mm in thickness. There is mild mucosal thickening and fluid signal in the anterior ethmoids and nasal cavity. The right extraocular muscles and optic nerve are unremarkable. There is no involvement retro-orbital fat. The left orbit is unremarkable. Brain: There are few scattered foci of subcortical and periventricular white matter, as well as pontine high T2 signal. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The pituitary gland and stalk appear to be unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable.
1.Right lacrimal gland enlargement, mild preseptal inflammation, right uveoscleral thickening, and what may represent an associated right subretinal collection. Differential considerations include IgG4-associated orbital and ocular inflammation, perhaps related to rheumatoid arthritis, sarcoidosis, or other granulomatous or autoimmune disorders and less likely neoplasm or atypical infection.2.Scattered mild nonspecific cerebral white matter signal abnormality may represent chronic small vessel disease. Otherwise, no evidence of intracranial meningeal disease or tumors.