The patient is a 68-year-old male with history of lung cancer status post resection and brain mets status post resection presenting with two days of confusion. In the area of the known posterior parietal lobe metastatic lesion seen on the comparison MRI, there is a 2.8 x 1.6 cm area of high attenuation consistent with hemorrhagic conversion of this lesion. Edema appears increased from the time of the comparison study. Effacement of the sulci is increased from the MRI secondary to the increase in edema, metastasis and subdural fluid. The second left parietal metastatic lesion is not well visualized on this examination.There are bilateral subdural hematomas, larger on the right. A high density component to the right sided subdural hematoma is consistent with an acute component to this subdural hemorrhage.The patient has undergone two craniotomies. Encephalomalacia and bony defects are seen in the right frontal and left parietal regions.The calvaria and skull base are radiographically normal except for the postsurgical changes. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. Progression of metastatic disease with hemorrhagic conversion of the left posterior parietal lesion.2. Subdural hematomas with acute component seen on the right.3. Increased edema and effacement of the sulci, but no herniation.