Diagnosis: Malignant neoplasm of upper lobe, right bronchus or lung Encounter for antineoplastic chemotherapy Disseminated malignant neoplasm, unspecified Secondary malignant neoplasm of brain Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm Encounter for examination for normal comparison and control in clinical research programClinical question: mets lung cancer, brain mets. Liver and adrenal mets; s/p 6 cycles of chemo, pls c/w previous study and evaluate treatment response. Please provide bi-dimensional measurements to all lesions per RECIST 1.1Signs and Symptoms: brain mets, s/p RT There is redemonstration of multiple foci of susceptibility effect where there were previously enhancing lesions on the 4/22/2015 exam. On the postcontrast T1 weighted images enhancing lesions are identified. A lesion on the surface of the left superior frontal gyrus currently measures 8 x 6 mm and previously measured 6 x 8 mm axial dimensions. The lesion along the right parietal lobe inferior parietal lobule adjacent to the occipital lobe measures 11x8 axial dimensions and on the October exam measured 13x 10 mm. On the April exam it measured 20 x 23 mm. A 3 mm enhancing nodule is present in the splenium of the corpus callosum at its junction with the septum pellucidum. This lesion previously measured similar size. Lesions which currently do not enhance but are associated with susceptibility effect include a left cerebellar lesion as well as the right temporal lobe lesion, right hippocampal lesion, right occipital lobe lesion, left precentral gyrus lesion.There continues to be T2 and FLAIR signal abnormality surrounding the above described lesions which appears stable when compared to the prior exams.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.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening along the left maxillary sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities in the right mastoid air cells. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.
1.Multiple lesions scattered throughout the brain are compatible with hemorrhagic metastases. There is mild regression of some of the enhancing lesions compared to the October exam. 2.Associated FLAIR signal abnormalities are stable.