65-year-old woman with breast cancer metastatic to the brain, status post craniotomy and whole brain radiation, with recurrent seizures in the past month. Evaluate for progression.. There are postoperative findings related to left parieto-occipital craniotomy without evidence of nodular enhancement to suggest tumor recurrence. There is unchanged confluent white matter T2 hyperintensity at the treatment bed. Right inferior cerebellar enhancing lesion, previously measuring 3x3 mm, now measures 6x6 mm, series 11 image 18. There is mild surrounding edema which is increased in the interval. There is a new punctate 2 mm right cerebellar lesion, axial image 40 of series 11.4 mm enhancing lesion more posteriorly in the right cerebellar hemisphere is stable to slightly smaller, series 11 image 37.There is a 5 x 4 mm right parietal enhancing lesion with mild surrounding edema which is new, series 11 image 105. There is an unchanged 6 mm enhancing lesion within the fundus of the right internal auditory canal. There is an unchanged developmental venous anomaly in the brainstem associated with cavernous malformations. There is unchanged mild periventricular white matter T2 hyperintensity. There is unchanged mild encephalomalacia in the left cerebellar hemisphere. Previously seen small right cerebral convexity subdural collection has resolved. Mild dural thickening and enhancement along the right frontal convexity may be related to prior subdural. There is no evidence of acute infarct. The ventricles and basal cisterns are stable in size and configuration, with ex vacuo dilatation of the left lateral ventricle. There is minimal midline shift to the left. There is minimal fluid signal within the left mastoid air cells. There is mild mucosal thickening in the paranasal sinuses. The skull and extracranial soft tissues are unchanged.
1. Compared to 12/18/2014, findings are suspicious for progression of intracranial metastatic disease. There is a new 5 x 4 mm right parietal lesion, a new 2 mm right cerebellar lesion, and a 6 mm right cerebellar enhancing lesion which has enlarged from 3 mm. 2. Unchanged subcentimeter lesion within the fundus of the right internal auditory canal, which may represent a schwannoma versus a metastasis. 3. Unchanged brainstem developmental venous anomaly associated with cavernous malformations.4. Resolution of previously seen right convexity subdural collection with right-sided dural thickening which may be reactive.