Male, 4 years old, with intracranial mass and ICH. Assess mass and postoperative changes. Brain:Sequelae of wide right sided craniectomy are again seen. A resection cavity is present along the right inferior temporal gyrus at least partially encompassing the previously seen area of focal cortical thickening and T2 hyperintensity. The resection cavity is hemosiderin stained and there is scattered susceptibility and T1 shortening within the adjacent parenchyma and sulci likely reflecting blood product from tumoral hemorrhage and related to surgery. Apart from blood product, there is probably also some irregular enhancement along the posterior margin of the resection cavityProgressive cortical thickening and T2 hyperintensity is seen within the right posterior cingulate gyrus, precuneus and lingual gyrus of the occipital lobe. These lesions show patchy associated enhancement which was not evident on the prior exam. Progressive cortical thickening and T2 hyperintensity without enhancement is seen involving the anterior right temporal lobe including the amygdala, the insula, and the perisylvian cortex. Relatively discrete foci of nonenhancing T2 hyperintensity are evident within the posterior right putamen, the right thalamus, right cerebral peduncle and left midbrain, new from the prior exam. Many of these described areas of cortical thickening and/or signal abnormality show mild associated restricted diffusion.Much of the mass effect seen on recent prior CTs has been relieved. There remains some degree of sulcal effacement in the right cerebral hemisphere and the right lateral ventricle is mildly effaced relative to the left. A very slight protrusion of the enhancing right lingual gyrus is seen across the tentorial incisure. The left lateral ventricle, third and fourth ventricles remain within normal limits.Spine:The visualized spinal cord, conus and cauda equina are within normal limits. No evidence of intramedullary or leptomeningeal enhancement is seen. The conus tip terminates at the T12-L1 level which is normal.A normal complement of vertebral bodies is present. Vertebral body morphology and signal characteristics are within normal limits. Spinal alignment is anatomic. No compromise of the spinal canal or neural foramina is suspected.Airspace opacity is seen at the lung bases bilaterally which may reflect atelectasis. Fluid is evident within the gallbladder fossa and there may be a small amount of gallbladder sludge layering dependently. The urinary bladder is distended with a catheter in place.
1.Sequelae of wide right-sided craniectomy are redemonstrated. Significant generalized cerebral mass effect seen on recent prior CTs has substantially improved.2.A resection cavity is evident along the right inferior temporal gyrus at least partially encompassing the region of cortical thickening and abnormal signal seen on the prior MRI. The resection cavity in the surrounding parenchyma and sulci show evidence of T1 shortening and hemosiderin staining compatible with residual tumoral and and procedure-related hemorrhage.3.Progressive cortical thickening, abnormal signal and patchy enhancement are now seen involving the right posterior cingulate gyrus, precuneus and lingual gyrus. These areas demonstrated less conspicuous abnormal signal and no enhancement on the prior examination.4.Also seen is progressive nonenhancing signal abnormality and cortical thickening involving the right anterior temporal lobe, insula and perisylvian cortex.5.Relatively discrete areas of new abnormal signal within the posterior right putamen, right thalamus, right cerebral peduncle and left midbrain are of uncertain significance. These could represent additional new sites of disease or they could perhaps reflect compressive or ischemic injury from the previously seen mass effect.6.Taken in total, the above findings likely reflect interval progression of high-grade tumor with multiple radiologically discontiguous sites of disease affecting the right cerebral hemisphere. As above, signal abnormality within the left midbrain is of uncertain significance at this point. No definite evidence of disease is seen within the left cerebral hemisphere or the cerebellum.7.Imaging of the spine reveals no evidence of leptomeningeal dissemination.8.Incidental findings include bilateral basilar airspace opacity which may reflect atelectasis, and fluid within the gallbladder fossa with mild layering gallbladder sludge.