Neuro_MR_Brain: 67 F, eye pain and swelling.

MRI BRAIN WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 65-year-old female, evaluate sinus lesion, history of metastatic breast cancer, with orbital cellulitis.

 

FINDINGS:

 

Parenchyma: No acute intracranial hemorrhage or acute infarct. Enhancing 3 mm focus in the high right frontal lobe is stable (image 1301:56).

Ventricles and extra-axial spaces: Appropriate for age.

Orbits: Rim-enhancing lesion at the opening of the left nasolacrimal duct, measuring approximately 14 x 10 mm in axial dimensions. The lesion demonstrates diffusion restriction. There is infiltration of the left extraconal and intraconal orbital fat, and mild left proptosis. There is left periorbital and left premaxillary soft tissue swelling.

 

Visualized paranasal sinuses: Enhancing lesion at the floor of the left maxillary sinus with involvement of the hard palate is stable (images 11:21 and 8:21). No evidence of recurrent disease within the nasal cavity. Partial opacification of the right frontal sinus.

 

Mastoid air cells: Clear.

 

Bones: Left maxillary sinus lesion involving the hard palate again seen.

 

Additional comment: Significant edema and enhancement in the superficial soft tissues in the left periorbital and zygomatic region.

  

IMPRESSION:

 

1.  Rim-enhancing lesion at the opening of the left nasolacrimal duct, favored to represent infected dacryocystocele/dacryocystitis, with adjacent orbital fat stranding and periorbital swelling. Per clinical history, the patient has had recurrent episodes of dacryocystitis at this location.

 

2.  Stable enhancing lesion at the floor of the left maxillary sinus involving the hard palate.

 

3.  Stable enhancing focus within the high right frontal lobe.

(Dacryocystitis)