50 years Male (DOB:12/25/1965)Reason: 3 t scanner History: surveillancePROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is a small focus of susceptibility effect present in the right middle frontal gyrus posteriorly measuring approximately 5 mm which is associated with surrounding vasogenic type edema with T2 and FLAIR hyperintensity. It enhances following gadolinium administration. On the prior exam it was barely visible and demonstrated punctate enhancement.Another focus of susceptibility effect is present in the right inferior parietal lobule. This associated with some thin ring enhancement pattern. The thin ring enhancing lesion now measures 10 mm and previously measured 19 x 12 mm.The patient is status post right parietal craniotomy. The craniotomy flap appears to be offset and is associated with the abdomen dilatation of the adjacent brain to the calvarial contour. There is susceptibility effect centered within the right postcentral gyrus probably resulting from prior treatment.T2 and FLAIR signal hyperintensity extends from T2 and FLAIR signal hyperintensity adjacent to right parietal lobe lesions to the posterior limb of the internal capsule and the suggestive of a wallerian degeneration.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 some mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear demonstrate some opacities in the left mastoid air cells. The visualized portions of the orbits are intact.
1.Since the prior exam a previously punctate lesion in the right frontal lobe has enlarged. This suggests metastatic disease.2.Since the prior exam the right inferior parietal lobe lesion has decreased in size and may represent posttreatment evolution.3.Status post right parietal lobe surgery. 4.There are some associated suggestion of Wallerian degeneration related to parietal lobe lesions.