63 years Male (DOB:3/25/1953)Reason: metastatic hnc History: metastatic hncPROVIDER/ATTENDING NAME: VASSILIKI SALOURA VASSILIKI SALOURA There is an extra-axial mass which involves the superior sagittal sinus posteriorly measuring approximately 68 x 15 x 24 mm. Inferiorly the torcula appears to be patent.There is a 4 mm enhancing focus present in the right cerebellar hemisphere. There is a 5 mm enhancing focus present in the right temporal lobe adjacent to the temporal horn of the left lateral ventricle. There is a 7 mm enhancing focus present in the left medial occipital lobe contiguous with the above described lesion. There is a punctate enhancing focus present in the left parietal lobe subcortical white matter. There is a punctate focus of enhancement along the right occipital lobe cortex. There is enhancing tissue behind the adjacent occipital calvarium associated with intervening loss of marrow signal suggesting that this mass extends through the occipital bone into the adjacent subcutaneous tissues.The cerebellum appears to be somewhat atrophic in appearance.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is a mass involving the distal aspect of the superior sagittal sinus which has enlarged relative to prior exams. It appears to be associated with occlusion of the superior sagittal sinus. The lesion appears to extend through the adjacent occipital bone and infiltration into the adjacent subcutaneous tissues behind the occipital bone. MR or CT venography would help confirm the occlusion of the superior sagittal sinus. It appears not to have been present in October 2015 to the extent of visualization possible. Differential considerations include metastases, meningioma, lymphoma, granulomatous lesion as well as other neoplasms potential involving superior sagittal sinus. Given findings suspicious for brain metastases metastasis would be high on the differential.2.There are multiple lesions scattered in the cerebellum and supratentorial brain which are suspicious for metastatic disease. These are not readily appreciated on the prior CT exams.3.Cerebellar atrophy4.Examination is degraded due to patient motion artifact which may obscure more subtle abnormalities.5.An email was sent to Dr Saloura at the time of this dictation.