Metastatic breast cancer. There is widespread heterogeneously enhancing tumor along the right cerebral convexity, measuring up to 8 mm in thickness, with mild mass effect upon the underlying brain. There is tumor along the left parietal convexity that measures up to 4 mm in thickness. There is diffuse smooth linear dural enhancement beyond the tumors, which is likely reactive. In addition, there is mild right frontoparietal leptomeningeal enhancement and T2 hyperintensity. There are minimal scattered cerebral white matter T2 hyperintense foci. There is no evidence of acute infarct or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are several enhancing lesions in the skull and in the C2 vertebra. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there are enlarged and heterogeneous bilateral upper cervical lymph nodes.
1. Bilateral cerebral convexity dural metastases, right greater than left, with underlying right frontoparietal leptomeningeal enhancement, which may be reactive or less likely represents carcinomatosis.2. Multiple osseous lesions likely represent metastases.3. Bilateral upper cervical lymphadenopathy likely represents metastatic disease as well. Dedicated imaging of the neck may be useful for further evaluation.4. No evidence of brain parenchymal metastases.