Radiology Questions #1
Summary
This is a call out to radiology to come forward and please help to read my CT and MRI scans. I have had unrelenting left-sided periocular pain, masseter and parotid pain for ten years. There has been no diagnosis, apart from sialolithiasis, which was identified in my parotid tissue after my partial parotidectomy in 2018. I have so many unanswered questions about the MRI and CT radiology images in my gallery. The radiology images show a stark difference between the left side of my face, where I experience pain, and the unaffected side. No explanation has been given to me about this marked difference. There is useful data in these scans, which could help me to attain a diagnosis and get the correct treatment for my condition. I am seeking a radiologist, who has an interest in Head and Neck Pathology, to answer my questions and read my radiology images.
My Periocular Pain
My periocular pain is the worst aspect of my facial pain. Orbital cellulitis was my initial diagnosis, which was triggered by a flea bite to my lower left eyelid in 2013. The area of pain that is most invasive is the left temporal artery area and around my upper eyelid and eyebrow. The region feels tight and heavy. It throbs, and my vision is now decidedly blurry in that eye. My periocular pain has worsened significantly in recent months. It is torturous enduring this pain, and I am extremely concerned about my blurry vision.
My Questions
In some of the MRI Neck images, there is visible swelling in the left temporal artery region. Could this suggest chronic temporal arteritis?
In many of the images, my left eye is smaller and less bright than the right eye. I understand that my left ptosis makes my eye small, but can a radiologist please explain why my left eye is less bright than the right one? Could it be because of reduced blood supply from the temporal arteries and vessels?
In the CT Neck images, there seems to be considerable pressure on my left eye, which is coming from all that is going on in my left cheek. Could this pressure be contributing to my periocular pain?
There has always been a connection between the pain and swelling in my eye and cheek. The radiology images show a visible connection between the two. There is a trail of white around my left eye, which extends all the way down my cheek. Could this of white be calcified tissue or infection?
My left eye does not look healthy. It is small, and it is considerably less bright than my right eye – but when I raised this with an ophthalmologist recently, he told me that it was the ‘angle plane of the scan.’ If there were a couple of images of a poorly looking left eye, I could accept this explanation. However, with so many images in my gallery, which show an unhealthy left looking eye, this does not resonate as true or accurate.
This is my body. It is my health. I am seeking answers, so that I can get treatment to recover the quality of my life. A correct evaluation of these images is the first step to me getting the right diagnosis. Please can a radiologist come forward and tell me if these scans offer any information about the cause of my eye pain.
My Left Cheek
I have acute pain in my left cheek. It starts at my zygomatic arch, and extends all the way down my cheek to the masseter and parotid area. I have had a partial parotidectomy, but a lot of my left parotid gland remains.
The MRI Neck radiology report from July, 2022 stated;
There is increased T2 signal and abnormal enhancement in the medial aspect of the left buccal fat pad, extending superomedially into the retro maxillary region. There is no suggestion of this being a primary sinus pathology and there is no evidence of periodontal disease. The masticator muscles do not appear involved with this process, but, the abnormal region does abut the medial surfaces of both masseter and medial pterygoid.
Impression;
There is abnormal signal and enhancement within the left buccal fat pad extending into the retro maxillary fat. This likely accounts for the patient’s symptoms, but it is not clear what this represents. It may be helpful to correlate with the pathology from the left partial parotidectomy. There is a focus of signal change in the remnant left parotid gland that likely represents a lymph node.
I have received no explanation re this abnormality. I did ask an Oral Maxillofacial surgeon what it was, but he attributed the abnormality to an UL6 molar tooth, with which I had a one-year problem following a faulty composite restoration. This has since had root canal treatment. The radiology report clearly states that there is ‘no sign of periodontal disease,’ so attributing the abnormality in my buccal fat pad to a painful tooth does not stack up. He also told me that it is a ‘coincidence’ that what I am seeing in these images is where I have the pain – that I am ‘choosing’ to see a problem. This does not resonate as true or accurate.
My Questions
Please could a radiologist tell me what this detected abnormality is in the retromolar and buccal fat pad region. What could be causing it? What is all the white in my left cheek? Could it be calcified tissue, or infection?
What information are these images providing re the cause of my facial pain? Is this an infection?
Conclusion
An Oral Maxillofacial surgeon recently told me that the MRI and CT images were completely normal. He said that my face looks different on each side because the images are all ‘off axis’ and ‘squint.’ If there were only a few images, which showed this stark difference between the two sides of my face, I may accept this explanation. However, there are 200 radiology images in my gallery, which show a marked difference between the two sides of my face. I cannot, therefore, accept that the difference in the two sides of my face is because the images are ‘off axis’, ‘squint’, or because I am ‘choosing’ to see a problem. I fail to understand what the object is of doing the scans in the first place, if the data is dismissed because it is all ‘off axis’ or ‘squint’ tomography?
Something is not adding up between what I see and what I am being told. I would not be in this much pain if there was nothing wrong. There is something there. I can see it – so can many others. Please can a radiologist come forward and explain what these images are showing. An accurate radiology read could help me to get a diagnosis and some long-awaited medical help.
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