Patient with worsening confusion and headaches. History of metastatic renal cell cancer with brain metastases. Undergoing whole brain radiation. Rule out bleed, edema, increased intracranial pressure. Nonenhanced CT of brain:Examination demonstrate a slightly high density mass in the basal cistern measuring 13 mm x 16.6-mm in transaxial dimension. There is evidence of edema in the hypothalamic and bilateral basal ganglia. Considering patient's provided clinical history of malignancy this finding could represent a metastatic focus. Further follow-up with an MRI is recommended to exclude other lesions in this location.Shunted lateral ventricles with complete collapse of right lateral ventricle and normal appearing third ventricle and left lateral ventricle.Foci of encephalomalacia in the right frontal lobe under a right frontal craniectomy may represent site of prior surgical intervention for removal of tumor. There is no evidence of hemorrhage or midline shift.Calvarium demonstrates right high convexity frontal craniotomy and is otherwise negative.Limited view of paranasal sinuses and mastoid air cells are unremarkable. Limited view of orbits are negative.
1.High density mass in the basal cistern/hypothalamic region with surrounding edema highly concerning for metastatic lesion considering provided history of renal cell cancer.2.No evidence of any additional metastatic foci and no evidence of midline shift or hydrocephalus.3.High convexity right posterior frontal encephalomalacia under a right frontal craniectomy.4.Calvarium, paranasal sinuses and mastoid air cells are intact.