Female, 24 years old, with history of melanoma, status post left-sided craniotomy for tumor resection. Assess for residual tumor and for small posterior fossa lesion. Evidence of left calvarial craniotomy is seen encompassing portions of the frontal and parietal bone. A small amount of extradural soft tissue thickening is seen subjacent to the craniotomy, within expected postoperative limits. Minimal residual intracranial air is seen.A small resection cavity is evident within the left middle frontal gyrus at the site of the previously seen lesion. The cavity contains a small amount of fluid and blood product. The rim of the cavity demonstrates thin enhancement which is typical after surgery. No definite nodular enhancing soft tissue is seen within or around the cavity. Along the inferior margin of the cavity, there is a curvilinear area of T2 hypointensity vaguely resembling a portion of the lesional hemorrhage seen on the preoperative study (see image 22 of series 7).The degree of T2 hyperintense edema surrounding the resection cavity is similar to that seen surrounding the lesion on the preoperative study. Elsewhere no evidence of significant parenchymal edema or mass effect is evident.A 4 mm enhancing focus is seen within the far lateral right cerebellum with no significant associated edema or mass effect (see image 79 series 13).A 6 mm focus of T1 hyperintensity which suppresses on fat-suppressed images is seen along the inferior frontal lobe on the left, just above the anterior clinoid process. On review of the prior outside CT examination, this lesion is visualized as an area of fat attenuation.No additional areas of pathologic intracranial enhancement are suspected. No other abnormal extra-axial fluid collections are seen. The ventricular system is normal in size and morphology.
1. Demonstration of expected findings status post left-sided craniotomy for resection of a lesion from the left middle frontal gyrus.2. Thin rim enhancement along the margins of the resection cavity is within expected postoperative limits. No solid nodular enhancing tissue is seen to suggest residual tumor.3. Along the inferior margin of the resection cavity, there is a curvilinear region of T2 hypointensity likely representing blood product. This material vaguely resembles a portion of the lesional hemorrhage seen on the preoperative examination, though it could also reflect blood product related to surgery. Attention to this area on follow-up examinations is suggested.4. A 4 mm enhancing lesion is evident in the right far lateral cerebellum which is suspicious for a second site of intracranial disease. This lesion induces no significant edema or mass effect.5. Note is made of a small fatty lesion along the undersurface of the left inferior frontal lobe which could represent an incidental lipoma or dermoid/epidermoid cyst.