Name of the Patient : Abc XyzNlmn / M / 50 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O right sided headaches with right sided squint (which has recovered), decreased hearing and tinnitus.

EXAMINATION :

M.R.I of the brain was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted axial images.

4 mm thick T1 Weighted and STIR coronal images.

4 mm thick T1 Weighted and T2 Weighted (with fat saturation) sagittal images.

OBSERVATION :

There is seen a fairly large, intermediate signal intensity mass lesion on the T1 Weighted images in the postero-lateral oropharyngeal and nasopharyngeal wall on the right, which appears relatively hypointense on the T2 Weighted images. This lesion is seen to involve the medial pterygoid muscle on the right and displaces the lateral pterygoid muscles, laterally. Involvement of the torus tabarius, fossa of Rosenmuller and the Eustation tube orifice is noted. The longus colli and the longus capitus muscle on the right also seem to be involved by the lesion. The right internal carotid artery and the skull base is displaced posteriorly by the lesion. The inferior extent of the lesion is upto the level of the body of the C2 vertebra.



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Superiorly, the lesion is seen to erode the floor of the middle cranial fossa and extends into the right parasellar region. The right inferior-temporal pole is displaced supero-laterally. There is extension into the right cavernous sinus, with encasement of the cavernous segment of the right internal carotid artery. Extension of the lesion into the sella per se is also noted. There is displacement of the pituitary gland and the pituitary stalk to the left side, although the pituitary gland cannot be well-differentiated in entirety from the mass lesion to the right of the midline. The clivus on the right shows altered signal with extension of the soft tissue lesion along the posterior margin of the clivus. There is erosion of the lateral and inferior walls of the sphenoid sinus on the right with extension of the mass lesion into the sphenoid sinus.

Anteriorly, the lesion extends upto the posterior margin of the ethmoidal air cells on the right and the right optic canal.

There is no focal altered of abnormal signal within the brain parenchyma per se on this study.

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 right mastoid air cells.

IMPRESSION :

A fairly large mass lesion along the postero-lateral wall of the oropharynx and nasopharynx on the right with extension through the skull base into the right middle cranial fossa and the sphenoid sinus as described is not specific for a single etiology. A nasopharyngeal neoplasm is a likely possibility.

A biopsy from the lesion would be worthwhile.