Clinical question: Evaluate right frontal swelling with mass-effect. Evaluate for recurrence of tumor. Signs and symptoms: Worsening right frontal headache and left arm and leg weakness. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.There is interval increased vasogenic edema in the right frontal lobe and extensively involving the right basal ganglia. There is resultant increased mass effect and midline deviation to the left of approximately 14 mm. There is no evidence of hydrocephalus. There is a large irregularly shaped necrotic thick irregular rim enhancing tumor in the right frontal lobe and with expiration to the corpus callosum and across the midline. The largest has axial measurements of tumor are at least 40 x 47-mm. The tumor extends from the high convexity cortex of right frontal lobe and nearly the floor of right anterior cranial fossa and measuring at least 58-mm in cranial cephalad axis. No detectable additional focus of abnormal enhancement. Periventricular increased flair signal intensity left hemisphere likely post treatment change.
1.Significant internal increased right frontal lobe vasogenic edema and large necrotic enhancing mass as detailed/measured above.2.There is 14-mm leftward midline shift and without evidence of hydrocephalus.