Age: 64
Sex: Male
Indication: Altered mental status, history of right mastoidectomy for resection of glomus jugulotympanicum tumor
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Case #40
Findings
- FLAIR signal hyperintensity within multiple right temporal sulci with associated leptomeningeal enhancement in these areas
- Mild widespread cortical FLAIR signal hyperintensity and indistinctness
- Enhancing mass centered at the right jugular foramen measuring 2 x 2 cm
- Irregularity and hypoenhancement of the distal right transverse sinus and right sigmoid sinus
- Mild patchy T2/FLAIR hyperintensities in the subcortical and periventricular white matter
- No evidence of acute infarct, hemorrhage, mass effect, or hydrocephalus
- T2/FLAIR signal hyperintensity in the right middle ear and right mastoidectomy bowl with associated enhancement
- Patchy T2 hyperintense signal about the bilateral optic nerve sheaths with associated enhancement
- Small mucous retention cysts in the left maxillary sinus
Diagnosis
- Meningoencephalitis
Sample Report
Findings concerning for meningoencephalitis, particularly involving the right temporal lobe. Fluid signal in the right middle ear and mastoidectomy bowl could represent postoperative changes but could also be a source for intracranial infection. Recommend contrast-enhanced temporal bone CT to assess for bony dehiscence. No extraaxial collection or evidence of parenchymal abscess.
Patchy T2 hyperintense signal about the bilateral optic nerve sheaths with associated enhancement may represent subarachnoid spread of infection along the optic nerve sheaths.
Enhancing mass centered at the right jugular foramen measuring 2 x 2 cm suggestive of residual or recurrent tumor. Recommend correlation with prior imaging.
Irregularity and hypoenhancement of the distal right transverse sinus and right sigmoid sinus, which may represent postsurgical change or sequela of chronic thrombosis.
No evidence of acute infarct, hemorrhage, mass effect, or hydrocephalus.
Mild patchy T2/FLAIR hyperintensities in the subcortical and periventricular white matter, which though nonspecific likely represent sequela of chronic small vessel disease.
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