New mental status changes. History of metastatic small cell lung cancer. There are multiple bilateral supratentorial and infratentorial enhancing lesions with extensive surrounding vasogenic edema, which are unchanged in size accounting for differences in technique. For example, the largest lesion is located in the left frontal lobe and measures up to 35 mm. Many of the lesions demonstrate susceptibility effects and restricted diffusion. There is unchanged 3 mm of rightward midline shift and partial effacement of the 4th ventricle. There is a background of mild cerebral white matter AAT2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute cerebral infarction. There is minimal mucosal thickening of the left maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.
Multiple supratentorial and infratentorial metastatic disease associated with extensive associated vasogenic edema and mild rightward midline shift. Many of the lesions contain hemorrhagic components, but have not significantly changed in size since the prior CT, accounting for differences in technique.