Date : 00.00.00

Name of the Patient : Abc Xyz A. Dhorajilmn / M / 68 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain and Orbits.

CLINICAL PROFILE :

C/O drooping of left eyelid 2-3 days back with diplopia on seeing with both eyes.
C/O watering the left eye, nose and around the left eye 4-5 days back.
Known diabetic.

EXAMINATION :

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

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

5 mm thick FLAIR coronal images.

3 mm thick T1 Weighted and STIR coronal images.

After administration of contrast the following parameters were used :

3 mm thick T1 Weighted coronal and axial images with fat saturation.

5 mm thick T1 Weighted axial and coronal images with magnetization transfer.

OBSERVATION :

There are areas of hypointensity on the T1 Weighted images which turn hyperintense on the proton, T2 Weighted and FLAIR images within the periatrial white matter bilaterally and these are most likely ischemic in etiology.



A suspicious intermediate signal intensity lesion is seen in the left cavernous sinus lateral to the internal carotid artery (scans 107.6, 106.6, 108.6). After administration of contrast there is faint enhancement of this lesion. The left carotid artery however shows normal flow-void signal.

There is mild fullness of both the lateral ventricles. The third and fourth ventricles are normal. There is mild prominence of the cerebral cortical sulci and cerebellar folia bilaterally.

The left lacrimal gland is enlarged and shows a hyperintense signal on the STIR images. After contrast administration it is seen to enhance more intensely than normal (scans 111.8, 106.18. 104.7, 107.16, 107.15, 108.15).

The extraocular muscles within both the orbits show normal contour, size and signal characteristics.

The intraorbital optic nerves are of normal size and reveal normal signal characteristics. Adequate perioptic CSF is evident on this study.

The superior orbital fissure and optic canal bilaterally are unremarkable.

Mucosal thickening is identified in the left maxillary and ethmoidal air cells.

The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
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IMPRESSION :

The MRI features are suggestive of :

1. An enlarged lacrimal gland with signal change and enhancement pattern as described. The differentially diagnosis may include :

a. Dacryoadenitis.

b. Neoplastic processes like epithelial neoplasia or lymphomatoid tumors.

2. A suspicious lesion within the left cavernous sinus ? pseudotumor ? granulomatous process.

A follow up scan would be worthwhile if clinically indicated.