58 years, Male, dysarthria, left frontal tumor. History of bladder cancer. There is a 3.4 x 3.7 x 3.6 cm enhancing mass in the left frontal lobe which demonstrates central necrosis. Minimal foci of susceptibility effect are also noted compatible with minimal associated blood products within the lesion. There is extensive surrounding T2 hyperintensity consistent with vasogenic edema with associated mass effect including sulcal effacement, effacement of the left lateral ventricle, and rightward subfalcine herniation. There is 5 mm rightward midline shift measured at the level of the foramen of Monro. There is also downward mass effect without uncal herniation. These lesions appear new compared to postcontrast CT from 12/10/2014.There is a 11 x 11 x 9 mm enhancing focus involving the left superior and middle temporal gyri consistent with a second lesion. There is mild associated edema.There is a 7 mm, punctate focus of restricted diffusion involving the left posterior temporal lobe, axial image 120 series 606 without corresponding T2 hyperintensity or enhancement, possibly artifactual. No definite evidence of restricted diffusion to suggest acute infarct. Major flow-voids are preserved.Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. No hydrocephalus. No extra-axial collections. No abnormal leptomeningeal or dural enhancement. Minimal paranasal sinus mucosal thickening involving the ethmoid air cells. Bone marrow signal and extracranial soft tissue structures are unremarkable.
1. Enhancing left frontal lobe mass as well as a smaller left temporal lesion are most consistent with metastatic disease.2. Vasogenic edema and mass effect, particularly associated with the left frontal lesion, results in rightward subfalcine herniation. There is also downward mass effect without uncal herniation.3. Apparent punctate focus of restricted diffusion in the left posterior temporal lobe without corresponding T2 hyperintensity favored to be artifactual.