Clinical question: Rule out aneurysm, intracranial hemorrhage. Signs and symptoms: Headaches. CTA of intracranial circulation:140 cc of Omnipaque 350 was administered for this exam.3-D reformatted images were obtained utilizing an independent workstation.Vertebral/basilar system.Normal appearing bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery, superior cerebellar arteries and posterior cerebral. No vascular abnormality in particular no aneurysm is identified as clinically is questioned. There is anatomical variation of proximal basilar artery fenestration.Right internal carotid.The distal cervical portion of right internal carotid artery, internal carotid artery across the skull base and the supraclinoid portion of right internal carotid artery remain within normal limits. There is no posterior communicating artery visible. There is anatomical variation of hypoplastic right A1. Right middle cerebral artery and its branches are unremarkable.Left internal carotid.There is patent normal appearing left internal carotid artery in its distal cervical portion and across the skull base. Normal-appearing supraclinoid left internal carotid artery. Nonvisualization of a left posterior communicating artery is an anatomical variation.There is a dominant left A1 supplying both A2 segments of the anterior cerebral arteries. There is no evidence of any aneurysm all anterior cerebral arteries, left middle cerebral artery or the supraclinoid left internal carotid artery. Incidental note is made of a slightly enlarged (compare to the right) left superior ophthalmic vein. There is high density of the left superior ophthalmic vein posteriorly in the retro-orbital space. The more anterior portion of the left superior ophthalmic vein demonstrate low density compared to its more posterior portion.. The exact etiology of this discrepancy in density is not clear. The hypodensity of the left superior ophthalmic vein posteriorly in the left retro-orbital space may present thrombus or contrast within a vessel. Please correlate with physical exam and patient symptomatology. This lesion can be further evaluated with an MRI exam if clinically is warranted.Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, cisterns cisterns and gray -- white matter differentiation remains within normal.An extra-axial dural based densely calcified lesion in high convexity right frontal lobe may represent a dural plaque or a very small heavily calcified meningioma. This finding was present on prior exam and is unchanged.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are unremarkable. Limited real paranasal sinuses demonstrate extensive opacification of right maxillary sinus.
1.No CTA of intracranial circulation for aneurysm as clinically is questioned. Fenestration of proximal basilar artery is noted.2.Slightly prominent left superior ophthalmic vein. Higher density of this vein in its more posterior portion in the retro-orbital space may represent clot or contrast. Please correlate with clinical findings, symptomatology and physical exam. If there is a concern and patient is symptomatic recommend an MRI examination.3.Stable unremarkable non-infused head CT. Stable small high convexity right frontal calcified dural based lesion measuring 8 times 6-mm in size since prior study. Right maxillary sinusitis.