Neuro_MR_Skull_Base: 67 M with DM, concern for NPC.

MRI SKULL BASE WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 67 years of age, male, history of nasopharyngeal/clival mass, concerning for malignancy, prior biopsies are nondiagnostic.

FINDINGS:

Bones: Extensive, ill-defined heterogeneous enhancement of the clivus is concerning for osteomyelitis. There is minimal enhancement along the dura adjacent to the clivus.

Soft tissues: Normal cavernous sinuses. There is extensive heterogeneous enhancement of the nasopharyngeal soft tissues, concerning for infection. This extends superiorly to the level of the foramen ovale and posteriorly into the right internal jugular foramen. The right internal jugular vein appears patent. There is no evidence of cranial nerve enhancement.

Visualized skull base foramina: Normal. Meckel's cave appears normal bilaterally.

Orbits: Left lens replacement.

Visualized paranasal sinuses: Mild mucosal sinus disease in the visualized paranasal sinuses.

Mastoid air cells: Large left mastoid effusion and trace right mastoid effusion.

Brain parenchyma: Encephalomalacia in the medial left occipital lobe appears unchanged, likely reflecting sequelae of remote infarct. No acute hemorrhage, infarction, mass, or abnormal enhancement. Confluent T2 hyperintense lesions are present in the white matter.

Ventricles and extra-axial spaces: Appropriate for age.

Additional comment: None.

IMPRESSION:

1.  Extensive heterogeneous enhancement of the nasopharyngeal soft tissues and clivus with extension to the right internal jugular foramen. No evidence of filling defect to suggest thrombosis in this vessel. Minimal enhancement of the dura adjacent to the clivus. Overall findings are highly concerning for soft tissue infection and osteomyelitis. No evidence of drainable fluid collection.