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/375/380 Date : 00.00.00

Name of the Patient : Abc XyzShlmn / F / 21 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Brain and Intracranial and Neck M.R.A/M.R.V.

CLINICAL PROFILE :

Known C/O venous angioma/lymphangioma in the left orbit.
H/O left frontal craniotomy with excision of orbital angioma in June 0000.
Received 4 sittings of sclerotherapy.

EXAMINATION :

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

5 mm thick T1 Weighted, proton and T2 Weighted axial images.

3 mm thick T1 Weighted and STIR coronal images.

3 mm thick T1 Weighted oblique sagittal images.

5 mm thick T1 Weighted sagittal images.

The MRA/MRV was performed using 2D TOF sequence.

OBSERVATION :

There are susceptibility artifacts in the left frontal region, the result of previous surgical intervention.

There is still seen a well-defined, intermediate signal intensity mass lesion on the T1 Weighted images in the left orbit. This lesion appears hyperintense on the proton, T2 Weighted and STIR images. The lesion extends from the orbital apex upto the posterior margin of the globe. Extension into the upper eyelid and inner canthus of the left orbit is also noted. The lesion is intraconal and extraconal in location and is seen to encase the superior rectus, medial rectus, inferior rectus and probably the superior oblique muscles. The left optic nerve is not well-identified separately from the lesion and is encased by the mass lesion. The left eye ball is displaced antero-inferiorly. Thinning of the roof and medial wall of left orbit is noted.
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There is a large, well-marginated lesion in the soft tissues, deep to the subcutaneous fat in the left maxillary region antero-inferior to the left maxillary sinus. This is isointense to normal muscle on the T1 Weighted images and turns heterogeneously hyperintense on the proton, T2 Weighted and STIR images and measures approximately 2.1 x 2.4 cms. No bony erosion or destruction is noted.

There are serpingenous flow void areas noted in the right cerebellar hemisphere, in the postero-lateral aspect of the pons, in the region of the inferior colliculus and in the region of vein of Galen which appears prominent and represent dilated vessels. Prominent vessels are also noted along the lateral wall of the left lateral ventricle.

There is no intracranial extension of the left orbital mass lesion. The right orbit, right optic nerve and the cavernous sinuses are unremarkable.

Note is made of a convex superior margin of the pituitary gland , which may be a normal for the patients age.

On the MRA and MRV, there is seen a fairly large vein draining into the vein of Galen on the left side. This vessel is seen in the left perimesencephalic cistern. The straight sinus, left transverse and sigmoid sinuses and the superior sagittal sinuses are prominent. The internal cerebral veins are unremarkable.

In the region of the left orbit, there is seen a prominent vascular channel in the left orbit (probably superior to the globe) which is seen to drain into a superficial vein in the left temporal region. This vessel, probably drains into the prominent vessel in the left perimesencephalic cistern, which then joins the vein of Galen.

The venous angioma in the right cerebellar hemisphere is not well delineated on the MRV.

No obvious arterial anomaly is identified on this study.

IMPRESSION :

In a known C/O venous angioma/lymphangioma the MRI features are suggestive of :

1. A recurrent/residual mass lesion in the left orbit with extensions as described.

2. A focal mass lesion in the soft tissues, deep to the subcutaneous fat in the left maxillary region antero-inferior to the left maxillary sinus. This lesion may also represent an angioma/lymphangioma.
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3. A prominent vascular channel in the left orbit which drains into a superfical vein in the left temporal region, which then, probably, drains intracranially, into a prominent venous channel in the left perimesencephalic cistern.

4. A prominent vein in the left perimesencephalic cistern, which drains into the vein of Galen, with prominent straight sinus, left transverse and sigmoid sinus.

5. No obvious arterial anomaly is identified on this study.

As compared to the previous MRI dated 00.00.00, there is increase in the size of the left orbital lesion.