Metastatic NSCLC treated with radiation. There are multiple, at least 12, supratentorial and infratentorial enhancing lesions with associated vasogenic edema. For example, a left posterior frontal lobe lesion measures up to 27 mm in diameter, previously 25 mm, and two contiguous right inferior parietal lobe lesions measure up to 40 mm, previously 36 mm, and contains hematocrit levels. Furthermore, many of the lesions have increased in size since 7/1/15. There are chronic lacunar infarcts in the bilateral basal ganglia and corona radiata. There is no evidence of acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a mildly expansile enhancing lesion in the left frontal bone with slight epidural and subgaleal extension. There is also an enhancing nodule within the right paraspinal muscles that measures up to 18 mm. The orbits are grossly unremarkable. There are secretions and mucosal thickening throughout the left maxillary sinus.
1. Numerous supratentorial and infratentorial metastases, some of which are hemorrhagic and have increased in size since 7/1/15.2. Left frontal bone metastasis.3. Right paraspinal muscle metastasis.