58 years Female (DOB:5/20/1957)Reason: lung mets to brain s/p SRS To L temporal and R frontal met and most recently whole brain radiation History: eval for extent of diseasePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA Since the prior exam multiple brain parenchymal lesions have increased in size. One in the posterior aspect of the left temporal lobe previously measured 7 x 7 mm now measures 12 x 12 mm axial dimensions. One in the left cerebellar hemisphere previously measured 10 mm and now measures 21 x 15 mm. One adjacent to the trigone of the left lateral ventricle was barely visible on the prior exam and now measures 9 x 12 mm. One in the right frontal lobe was not present on the prior exam measures 4 mm. One in the right middle frontal gyrus measures 12 mm and previously measured 3.5 mm. One adjacent to the the right precentral sulcus in the right precentral gyrus measures 6 mm and previously measured 2 mm. There is edema present in the posterior fossa associated with the left cerebellar lesion which partially distorts the fourth ventricle and mildly crowds the posterior fossa.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 demonstrate scattered opacities. The visualized portions of the orbits are intact.
1.Since the prior exam patient's metastatic lesions have increased in size . In addition there are a couple new brain metastatic lesions.2.There is more mass effect in the posterior fossa the current exam relative to the prior exam which is related to vasogenic edema from a metastatic lesion.