26 years, Male, multifocal lesions in the left hemisphere with vasogenic edema. First-time seizure. There is an intensely enhancing T2 hypointense mass involving the left cingulate gyrus and callosal body measuring approximately 4.6 x 2.4 x 1.7 cm in the AP, transverse, and craniocaudal dimensions. There is an additional left parietal mass more posteriorly involving the precuneus which measures approximately 12 x 15 x 14 mm. There is surrounding vasogenic edema as well as local mass effect. Mild edema extends across the corpus callosum. No associated hemorrhage aside from a punctate focus of susceptibility involving the left frontal lesion which may represent microhemorrhage. There is associated mild restricted diffusion. Additionally, there are small foci of FLAIR hyperintensity involving the left frontal subcortical white matter, in the right posterior frontal lobe, right parietal lobe, as well as in the right periatrial white matter; there is mild restricted diffusion associated with these lesions without appreciable enhancement.Mass effect includes downward displacement of the corpus callosum and lateral ventricles. No significant midline shift at the level of the foramen of Monro. No uncal herniation. No hydrocephalus. There is mild, nonspecific prominence of the nasopharyngeal lymphoid tissue. There is a small right maxillary mucus retention cyst. Calvarium and extracranial soft tissues are otherwise unremarkable.
Enhancing masses in the left frontal and parietal lobes with multiple additional smaller nonenhancing lesions in the bilateral frontal and parietal lobes with mild restricted diffusion. Findings are most favored to represent lymphoma, with tumefactive demyelination a less likely possibility.