 There are 2 intra-axial enhancing lesions within the right frontal lobe. The lesions are heterogenous on T1 and T2-weighted images and demonstrate susceptibility artifact compatible with associated blood products. Both lesions are surrounded by signal abnormality compatible with vasogenic edema. The larger lesion is centered within the deep white matter of the right frontal lobe, and the enhancing component of which measures 23 x 36 x 10 mm. This lesion also has associated prominent flow voids indicating vascularity. The smaller lesion is centered within the right superior frontal gyrus, the enhancing component which measures 9 x 9 x 10 mm. There is associated mass effect including sulcal effacement in the right frontal lobe, approximately 5 mm of leftward midline shift, and partial effacement of the right lateral ventricle. The basal cisterns are maintained. There are additional punctate foci of abnormal enhancement within the bilateral cerebellar hemispheres which are suspicious for additional metastatic lesions. The puncture lesion in the right cerebellar hemisphere demonstrates associated susceptibility artifact. There is no territorially restricted diffusion to suggest acute ischemic infarction. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.
Hemorrhagic metastases within the right frontal lobe with associated right hemispheric mass effect and midline shift. Additional cerebellar lesions also suspicious for metastases.