PMC9997598_01
Axial diffusion-weighted imaging (DWI) (left) and coronal T2 weighted images (right) show symmetrical changes within bilateral lateral geniculate body (arrows) with foci of blooming on susceptibility weighted imaging (SWI) (middle) concerning for hemorrhagic necrosis
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F1
Repeat MRI of the brain and orbit revealed bilateral subacute hemorrhagic necrosis with T1 shortening, punctate foci of blooming, and subtle enhancement with altered diffusivity noted within the region of LGBs with adjacent peri-lesional signal changes extending along optic pathway structures including optic tract [Figure 1].
Axial contrast CT image (left) confirms bulky pancreas with thickening of anteroconal and lateroconal fascia (red arrow). Coronal contrast CT image (right) confirms pseudocyst within uncinate process (white arrow) while bile duct is seen separately (red arrow)
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F2
C antibody titers, and 2D echo to rule out infective endocarditis were normal. CT chest revealed thin left pleural effusion with minimal pericardial effusion with coronavirus disease 2019 reporting and data system (CORADS) score of 1, CT abdomen confirmed acute pancreatitis (CT severity score of 4) [Figure 2], and after extensive blood work up including peripheral blood smear, disseminated intravascular coagulation profile, extractable nuclear antigens 6 profile, Coombs test, etc., she was diagnosed to have thrombotic microangiopathy (microvascular occlusion), bilateral LGB hemorrhagic infarct, acute pancreatitis with starvation, and dehydration shock.
Follow-up images after 3 months shows residual blooming on SWI (middle arrow) with resolution of DWI and T2 changes
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F3
On review, after discharge from the hospital, her MRI revealed resolution of fluid-attenuated inversion recovery hyperintensities in LGB bilaterally with residual blooming suggestive of old hemorrhagic gliosis [Figure 3].