Diagnosis: Malignant neoplasm of parotid gland Disorder of brain, unspecified Abnormal findings on diagnostic imaging of other specified body structuresClinical question: h/o HNC and CRTSigns and Symptoms: new brain lesions as found on last CT scans The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 23x 19 mm homogenously enhancing mass with intermediateT2 signal, located in the right precuneus associated with vasogenic edema.There is a14x15 mm axial dimension homogenously enhancing mass with highT2 signal, located in the right basal ganglia.There is a 24x25 mm axial dimension homogenously enhancing mass with heterogeneous T2 signal, located in the posterior aspect of the right gyrus rectus and medial orbital gyrus extending to the posterior orbital gyrus. It is associated with vasogenic edema.There is a12x11 mm axial dimension homogenously enhancing mass with high T2 signal, located in the right cerebral peduncleThere is a11x11 mm axial dimension homogenously enhancing mass with lhighT2 signal, located in the left middle temporal gyrus next to the left inferior temporal sulcus. It is associated with vasogenic edema.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.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Incidental note is made of partial empty sella.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The visualized portions of parotid glands are asymmetric.
1.Multiple enhancing masses within the supratentorial brain as detailed above. The possibility of metastatic disease cannot be excluded.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 