Esophageal cancer with history of brain metastases. Previously seen left frontal lobe lesion with hemorrhage demonstrates decrease in enhancement, with mild residual area of enhancement measuring approximately 11 mm, previously approximately 13 mm on the sagittal sequence. There is cystic change which may relate to volume loss. Surrounding T2/FLAIR hyperintensity is not significantly changed and may represent gliosis and/or edema. Left temporal occipital lesion with T2 hyperintensity demonstrates no significant enhancement and measures 22 x 15 mm similar to prior. Surrounding FLAIR hyperintensity related to edema or gliosis is also not significantly changed.There is a 7 x 7 x 9 mm enhancing lesion involving the right occipital lobe which appears new since prior. There is mild surrounding edema.There is mild increase in T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter, particularly involving the right posterior frontal corona radiata which is favored to be related to posttreatment change. No underlying enhancing lesion is evident. Additional scattered foci of T2/FLAIR hyperintensity are nonspecific but compatible with small vessel ischemic disease and/or posttreatment-related changes. There is global parenchymal volume loss as seen before. No evidence of significant intracranial mass effect, midline shift, or herniation. No hydrocephalus. There is persistent fluid within the bilateral middle ears and mastoid air cells and mild scattered paranasal sinus mucosal thickening. No destructive calvarial lesions are evident.
1. Slight interval decrease in size and enhancement of hemorrhagic left frontal lesion with surrounding edema/gliosis not significantly changed. Lesion is compatible with treated metastasis. Nonenhancing left temporal occipital lesion is not significantly changed in size and compatible with treated metastasis.2. New 7 x 7 x 9 mm enhancing lesion involving the right occipital lobe. No other new lesions are appreciated.3. Slight increase in T2/FLAIR hyperintensity in the periventricular and subcortical white matter favored to represent posttreatment change.4. No significant intracranial mass effect, midline shift, or herniation.5. Persistent effusions involving the bilateral middle ears and mastoid air cells which may represent otomastoiditis.