Female, 40 years old, with metastatic breast cancer to the brain, status post resection of a brain lesion, evaluate for resection and for question of new altered mental status prior to surgery. Postoperative findings are seen compatible with a left frontal craniotomy for tumor resection. The previously demonstrated dominant left frontal lobe lesion has been excised. A surgical cavity is evident in its place which is filled with a mixture of air, fluid and blood product. The tumor appears to have been nearly completely resected. A 12 mm region of enhancement along the inferior aspect of the cavity, adjacent to the left frontal horn, most likely represents a small amount of residual tumor. Scattered subcentimeter foci of enhancement elsewhere along the margins of the resection cavity are nonspecific. Edema in the surrounding parenchyma related to this lesion appears to be slightly improved from the preoperative examination.The second largest lesion within the right parietal lobe continues to measure up to 26 mm in length showing no significant interval change. Moderate edema associated with this lesion is also grossly unchanged. Approximately 15 additional scattered parenchymal enhancing lesions are also redemonstrated ranging in size from punctate up to 1 cm. These involve both cerebral hemispheres, the brainstem and cerebellum. There has been no significant interval change in the size or number of these lesions.Local mass effect persists in the left frontal and right parietal lobes. The smaller lesions cause no significant parenchymal mass effect. No evidence of brain herniation is seen. No diffusion restriction is seen apart from the expected cytotoxic edema along the resection cavity margins. The ventricles are stable in size and morphology.
1.Findings are seen compatible with near complete resection of the large left frontal lobe tumor. A small amount of residual tumor is seen along the inferior margin of the resection cavity. Scattered small foci of enhancing tissue elsewhere along the cavity margin are nonspecific.2.The second largest metastatic lesion, in the right parietal lobe, shows no significant interval change in size and continues to induce a similar degree of edema and mass effect.3.Numerous additional small parenchymal metastases are redemonstrated without significant interval change.