A preliminary lateral topogram of the cranium was obtained. Volume scans were then performed with OM line as reference and employing 0.625 mm sections.
OBSERVATIONS:
INFRATENTORIAL REGION:
Cerebellar hemispheres are normal.
Fourth ventricle is normal in size. CP angle is normal.
Brainstem is normal.
SUPRATENTORIAL REGION:
Multiple calcific foci noted along the sub-ependymal regions of both lateral ventricles, right periventricular region and right medial temporal lobe (adjoining the temporal horn of lateral ventricle).
Rest of the brain parenchyma shows normal attenuation.
No evidence of any obvious infarct or intracranial haemorrhage.
3rd ventricle is normal. No midline shift.
Cortical sulci and sylvian fissures are normal. Basal cisterns are normal.
Sella and parasellar regions are normal.
Visualized paranasal sinuses and orbits appear normal.
OBSERVATIONS:
OBSERVATIONS:
LIVER: Normal in size, shape, outlines and parenchymal attenuation. Tiny 3mm fat density lesions seen in segment II, VIII and IVA. Porta hepatis and portal vein are normal. Intrahepatic portal venous radicals are normal. No evidence of intrahepatic biliary radicular dilatation. Hepatic veins and intrahepatic portion of inferior venacava are normal.
GALL BLADDER: Normal in size, shape and outlines. Pericholecystic area is normal.
Common bile duct is not dilated.
SPLEEN: Spleen is normal in size, shape and attenuation values. Post contrast sections show no significant point of note. Splenic hilum and splenic vein are normal.
PANCREAS: Pancreas is normal in size, contour and attenuations values. No evidence of focal mass lesion/pancreatic duct dilatation. Post contrast sections show no significant point of note.
RIGHT KIDNEY:
Bulky in size and shape. It shows good concentration and prompt excretion of contrast. No evidence of hydronephrosis/calculi.
Right kidney measures 12.5 cm; parenchymal thickness 2.1 cm.
Multiple cortical cysts are seen of varying sizes; measuring ~14-20mm.Few of these are exophytic.
Multiple fat density lesions are seen of varying sizes measuring ~ 4-15mm.
No evidence of any obvious arterial enhancement seen within the lesions.
LEFT KIDNEY:
Normal in size and shape. The renal outline is normal and shows good concentration and prompt excretion of contrast. No evidence of hydronephrosis/calculi.
Left kidney measures 13.5 cm; parenchymal thickness 2.1 cm.
Multiple cortical cysts are seen of varying sizes; measuring ~10-35mm. Few of them are exophytic.
Multiple fat density lesions are seen of varying sizes measuring ~ 4-19mm.
No evidence of any obvious arterial enhancement seen within the lesions.
Visualised portions of ureters are normal.
There is evidence of a well-defined fat density lesion seen along the lateral limb of the right adrenal gland measuring ~19x12mm.
A 13x9mm well defined lesion seen along the lateral limb of the left adrenal gland.
A 29x20mm hypodensity seen in the pre caval region, posterior to the 3rd part of the duodenum
Aorta and extra hepatic portion of inferior venacava are normal in calibre.
Visualised small / large bowel loops appear normal. No evidence of any obvious stricture or any abnormality dilated bowel loop. Mesentery and its contents in the visualised sections are normal.
Urinary bladder is normal in size and attenuation.
Uterus & Ovaries appear normal. A 13mm fundal fibroid is seen.
No evidence of significant lymphadenopathy. No evidence of ascites.
Small ventral hernia with defect measuring ~8mm in the supra-umbilical region(~2cms from the umbilicus)containing omentum.
Visualised sections through the lung bases are normal.
Visualised sections through the dorso lumbar spine shows:
- Sclerosis along the posterior elements of the vertebral bodies.
- Sclerotic focus in the L4 vertebral body.
- Sclerosis in the bones forming the pelvis.
IMPRESSION:
Ø Bilateral renal cortical cysts. Bilateral renal angiomyolipomas.
Ø Bilateral adrenal angiomyolipomas. Few small hepatic lipomas.
Ø Small hypodensity in the pre caval region posterior to the 3rd part of the duodenum-Short segment of dilated Lymphatic duct (Retroperitoneal LAM).
Ø Sclerosis along the posterior elements of the vertebral bodies. Few sclerotic foci in the bones forming the pelvis and L4 vertebral body.
**In view of calcified lesions along the sub-ependymal regions and caudo thalamic groove- Possibility of Tuberous Sclerosis to be considered.
*Suggested MRI brain.