Clinical question: Altered mental status. Signs and symptoms: Known PNET with edema. Unenhanced CT of brain:On axial image 15 there is a soft tissue density mass at the level of the cranial gland which is a new finding since prior study. This mass measures 15.5-mm x 14.5-mm. In comparison with prior examination there is further expansion of brain parenchymal through the left temporal rhinectomy site. The underlying brain parenchymal demonstrate lower density which may indicate further encephalomalacia. There is also further increase in the size of the left temporal horn secondary to ex vacuo cavitation. Diffuse low attenuation consistent with edema in the left frontal lobe with extension into the corpus callosum however is a new finding since prior exam. This results in mass effect and slight deviation of midline in the anterior frontal region. There is also extensive low-attenuation in the pattern of vasogenic edema in the right hemisphere which is also new since prior exam. There is further dilatation of the lateral ventricles. The combination of above findings results in slight effacement of cortical sulci on the right side.Above-described findings could be secondary to obstructive hydrocephalus due to presence of a new mass at the level of pineal gland. Further evaluation with an MRI is recommended.Images through posterior fossa are stable and unremarkable.
1.New mass measuring 15.5-mm x 14.5-mm and the pine needle region.2.Interval increase in the size of the supratentorial ventricular system which is concerning for obstructive hydrocephalus. Extensive edema of brain parenchyma which may represent trans- ependymal exudate of CSF. Further evaluation with an enhanced MRI is recommended to evaluate for other possible causes for extensive bilateral white matter edema.