Clinical question: Evaluate for interval change. Signs and symptoms: Status post removal of calvarial implant with resection of recurrent tumor. Nonenhanced head CT:Examination demonstrates a large left temporal and parietal craniectomy.The parietal bone posterior to the craniectomy site demonstrates extensive lytic changes which traverses the midline to the right paramedian. This is a new finding since prior exam and is best appreciated on axial images 27 through 30. Finding is concerning for osteomyelitis. Fluoroscopy and an enhanced MRI exam is recommended.There is a surgical drain traversing the craniectomy site.There is no evidence of intracranial hemorrhage.There is a focus of encephalomalacia in the left posterior temporal similar to prior study.There is diffuse decreased density of left posterior frontal parietal white matter similar to prior study. This is believed to represent either residual in the normal and or partial encephalomalacia considering the duration of presence of this finding. There is slight ex vacuo dilatation of the left lateral ventricle and without evidence of midline shift. Follow up with an enhanced study is limited for better overall assessment.
1.There is interval surgical removal of a large craniotomy flap in the left temporal -- parietal and frontal as described.2.Negative changes of the posterior edge of craniectomy site is a new finding since prior exam.3.Extensive residual vasogenic edema and or combination of edema and encephalomalacia in the left hemisphere.4.No evidence of intracranial hemorrhage or midline shift.