Initial non-contrast examination demonstrates a small cluster of serpiginous mildly hyperdense structure is in the right frontal lobe superiorly. There is a small region of surrounding gliosis. No acute haemorrhage. Remainder of the brain has normal appearances. No hydrocephalus.
CT angiogram Circle of Willis - Arterial phase contrast enhanced scans from arch to vertex demonstrates a bovine configuration of the aortic arch.The common and internal carotid arteries and vertebral arteries in the neck are normal. No intracranial stenosis or occlusion.
Nidus of tortuous vessels in the right superior frontal sulcus measures approximately 11 mm, supplied from a branch of the right anterior cerebral artery and draining to the superior sagittal sinus. There are at least 2 rounded enhancing structures lurched of the nidus which may represent intra nidal aneurysms or (more likely) venous varices. Note made of hypoplastic right A1 segment and large anterior communicating artery. A 2.8 centimetre pulmonary arteriovenous malformation is identified in the right upper lobe. There is mild surrounding groundglass opacity.
Conclusion: Small right frontal arteriovenous malformation with either intranidal aneurysm or varix but no evidence of deep drainage. No evidence of recent bleed. Presence of a right apical pulmonary AVM suggests underlying hereditary haemorrhagic telangiectasia (HHT).