Diagnosis: Neoplasm of unspecified nature of brainClinical question: s/p brain tumor resectionSigns and Symptoms: s/p brain tumor resection There is a 61x56mm sagittal dimension heterogenously enhancing mass in involving the deep white matter of the right frontal lobe and the adjacent subcortical white matter of the right parietal lobe . There is adjacentT2/FLAIR signal hyperintensity compatible with vasogenic edema in an area measuring 91x64 mm axial dimensions. There are satellite foci of enhancement in the adjacent brain. There is susceptibility effect within the mass. Since the prior exam there are more blood products within the mass.The patient is status post recent right sided craniotomy. There is an underlying subdural collection measuring up to 9mm thickness. There is mass effect with 10 mm right sided shift of the septum pellucidum at the level of the internal cerebral veins. This midline shift has increased compared to the prior exam. There is mild uncal herniation present and subfalcine herniation. The right lateral ventricle is compressed.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.Since the prior exam the patient's right hemispheric mass has developed more hemorrhage and mass effect with slightly greater midline shift. There is mild uncal herniation present.2.Since the prior exam the patient has undergone craniotomy. There is a small extra-axial fluid collection at the craniotomy site.