CT findings are consistent with Neurofibromatosis type I (NF1) Von Recklinghausen disease with the
following features.
Recurrent infiltrating Plexiform Neurofibroma.
Sphenoid hypoplasia.
Buphthalmous.
Apparent optic nerve glioma.
Post operative fixation of the roof and lateral
The liver is of average size with regular contour with moderate dilated
intra hepatic biliary radicles on both lobes more at left one and an ill
defined small iso dense focal hilar mass lesion. It is associated with
thickening of the conflu...ence of left and right hepatic ducts. It shows
minimal patchy contrast enhancement. No detected portal vein or hepatic
artery invasion. it is associated with wall thickening of the gall bladder
with no detected definite intervening fat plane .
Patent portal vein.
Normal diameter of common bile duct. No ductal stones.
Normal appearance of the pancreas. No dilatation of the pancreatic duct.
Opinion:
Extra hepatic biliary obstruction at level of confluence of right and left
hepatic ducts and distal to cystic duct ( gall bladder not distended) by ill
defined hilar heterogeneous mass.suggestive of hilar
cholangiocarcinoma (klatskin tumor) with possible gall bladder infiltration
in 83 old female.ERCP with adjuvant biliary stenting is recommended.
Diffuse thickening of the supra and infra tentorial leptomeninges, basal cisterns and subarachnoid CSF spaces
associated with abnormal high SI on FLAIR sequances and T1 WIs. They shows nodular (at right parietal lobe sub
arachnoid CSF space) and smooth diffuse enhancement in post contrast study (dirty CSF).
Diffuse thickening and enhancement of the pia of folia, floor and posterior surface of the 4th ventricle.
Mild enhancement of the cranial nerves at the both CPAs.
Abnormal SI linear areas seen at the posterior limb of both internal capsules. They display low SI on T1 WIs and
high SI on T2 and FLAIR images. No detected contrast enhancement.
Elongated finger-shaped CSF SI on all pulse sequence cavum septum pelluicidum and cavum vergae associated
with bowing the leaves of the septum pelluicidum. They are seen between the frontal horns and extend
posteriorly between fornices of body of lateral ventricles. It measured about 1.2 cm in diameter.
No detected localized intra axial SOL at the posterior fossa.
Mild infra and supra tentorial ventricular system with evidence of right side shunt tube with its tip at right lateral
ventricle.
No gross vascular abnormality.
Normal brain stem.
Opinion:
Diffuse leptomeningeal and sub arachnoid carcinomatosis (metastases)..CSF seeding from previous surgically
removed Medulloblastoma (posterior fossa PNET).
Ependymal spread of metastasis along the floor and posterior wall of 4th ventricle.
No detected recurrent or residual posterior fossa enhanced localized SOLs.
Cavum septum pelluicidum and cavum verge (normal variant).
Arrested hydrocephalic changes with shunt tube seen at the occipital horn of the right lateral ventricle.
Gliotic changes of the posterior limb of both internal capsules
Multiple small intra medullary SOL seen involving the entire cervical and
dorsal cord. The displays low SI on T1 WIs and high SI on T2 WIs. They
show mild heterogeneous contrast enhancement.
Dirty sub arachnoid CSF with increased intensity (ground glass
appearance). They shows marked contrast enhancement along the spinal
cord with characteristic sugar coating appearance.
Marked enhancement of the spinal cord lining and nerve roots.
Normal diameters of the bony spinal canal.
Preserved height and T2 signal brightness of the lumbar intervertebral
discs.
No evidence of disc herniations or significant bulges.
Normal marrow signal of the imaged vertebrae.
Opinion:
Multiple drop intra medullary metastases.
Diffuse leptomeningeal tumor spread CSF disseminated metastases from
the previous operated Medulloblastoma (posterior fossa PNET).
X-ray Appearance
1. Typically, diffuse ground-glass or finely granular
appearance
2. Bilateral and symmetrical distribution
3. Air bronchograms are common
-Especially extending peripherally
4. Hypoaeration in non-ventilated lungs
-Hyperinflation excludes HMD
5. Granularity is the interplay of
1. Air-distended bronchioles & ducts
2. Background of atelectasis of alveoli
6. May change from film-to-film if there is
1. Expiration (air disappears)
2. Better aeration (small bubble formation
CHONDROCALCINOSES
No evidence of new sclerotic bone formation.
No detected vascular invasion.
No detected separable enlarged lymph nodes.
No air density could be seen.
Patent left osteomeatal units and
sphenoethmoidal recesses.
Clear nasopharynx and oropharynx
OPINION:
CT findings are consistent with large soft tissue
mass centered on right maxilla with marked bone
destruction and above described
extensionsSuggestive of malignant process
rather than infectious process corresponding the
given history..Mostly squamous cell
carcinoma/adenocarcinoma.Biopsy is highly
recommended