70 years Male (DOB:7/7/1946)Reason: Eval grade 2 astrocytoma. Pt on CCNU. History: grade 2 astrocytoma.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is T2 and FLAIR signal hyperintensity involving right basal ganglia, thalamus, insular cortex and adjacent right frontal lobe which extends to involve gray and white matter of the insular cortex and right orbital gyrus and right inferior frontal gyrus as well as the anterior aspect of the right temporal lobe. It does not display any contrast enhancement. On the current exam there is new T2 signal hyperintensity which extends further superiorly and posteriorly into the right frontal lobe white matter and further posteriorly in the right temporal lobe white matter. This is a new T2 signal hyperintensity is higher signal than the rest of the lesion. There is an associated cystic component measuring 35 x 28 mm axial dimension in size within which on the March exam measured 12 x 17 mm axial dimensions. There is an enhancing component which is enlarged relative to the prior exam and encircles a cystic component. It measures 52 x 42 mm axial dimensions on the current exam and previously was rather patchy. The enhancing component demonstrates elevated cerebral blood volume.The patient status post right frontal craniotomy.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and mucosal thickening elsewhere in the paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
There is an infiltrating mass involving right frontal lobe, anterior temporal lobe, insular cortex, right thalamus and basal ganglia. Since the prior exam T2 and FLAIR signal hyperintensity associated with the lesion has progressed. It is possible this represents vasogenic edema with or without tumor infiltration. Additionally, the contrast enhancing component of the lesion associated with a cystic lesion which has enlarged since the prior exam and is associated with elevated blood volume suggesting recurrent higher grade infiltrating astrocytoma.