Name of the Patient : Abc XyzFalmn / F / 60 yrs.
Referred by : Dr. Abc Xyzabolkar.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O bilateral nasal polyps with intracranial extension.
M.R.I of the brain was performed using the following parameters :
5 mm thick T1 Weighted, proton and T2 Weighted axial images.
5 mm thick T1 Weighted and FLAIR coronal images.
5 mm thick T1 Weighted sagittal images.
There is evidence of an intermediate signal intensity, soft tissue lesion on the T1 Weighted images in the paranasal sinuses and the nasal cavity, bilaterally. This lesion appears heterogeneously hyperintense on the proton, T2 Weighted and FLAIR images. There is resultant scalloping of the walls of the paranasal sinuses, widening of the osteomeatal complexes bilaterally with probable destruction of the air spaces and septae of the ethmoidal air cells bilaterally. There is intracranial extension of the lesion into the right cavernous sinus with destruction of the roof and right lateral wall of the sphenoid sinus. Resultant encasement of the cavernous segment of the right internal carotid artery is noted with mild displacement
of the pituitary gland to the left. There is no extension of the lesion into the orbits on either side. Polypoid lesions are seen to extend into the nostrils on either side.
There are small bright foci on the proton, T2 Weighted and FLAIR images in the posterior parietal periventricular white matter bilaterally and in the fronto-temporal subcortical white matter bilaterally. These lesions appear near isointense to white matter on the T1 Weighted images and most likely represents ischemic changes.
Lacunar infarcts (iso to hyperintense to CSF) are noted in the head of the right caudate nucleus.
Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.
Inflammatory changes are noted in the mastoid air cells bilaterally.
1. Soft tissue mass lesion in the paranasal sinuses bilaterally with extension into the nasal cavity and the right cavernous sinus as described is not specific for a single etiology. This is most likely inflammatory in etiology, probably a fungal lesion. The possibility of a neoplasm is less likely.
2. Altered signal in the posterior parietal periventricular white matter bilaterally and in the fronto-temporal subcortical white matter bilaterally most likely represents ischemic changes.
3. Lacunar infarcts in the head of the right caudate nucleus.