Lung cancer with new headaches. There is a new widely diffuse left calvarial lesion with irregular, enhancing left holocerebral convexity extra-axial tumor extension that measures up to 10 mm in thickness along the inferior left temporal lobe. There are foci of susceptibility effect associated with portions of the tumor, which may represent hemorrhage and/or calcification. There is also a fluid collection in the left frontal convexity subdural space that measures up to 8 mm in thickness. There is overall mild mass effect upon the underlying brain parenchyma and slight midline shift to the right. In addition, the tumor appears to compress or perhaps invade the left sigmoid sinus. The left calvarial tumor also extends into the overlying subgaleal space, measuring up to 7 mm in thickness. There are smaller enhancing lesions within the right and mid frontal calvarium without epidural or subgaleal extension. There is no evidence of intraparenchymal brain tumors or acute infarct. There is no herniation. The major cerebral flow voids are intact. There is scattered mucosal thickening within the left mastoid air cells, which may be related to compromise of the regional venous drainage. The orbits and paranasal sinuses are grossly unremarkable.
New widely diffuse left calvarial metastasis with epidural tumor extension that measures up to 10 mm in thickness, with foci of susceptibility effect associated with portions of the tumor, which may represent hemorrhage and/or calcification. A fluid collection in the left frontal convexity subdural space that measures up to 8 mm in thickness may represent an epitumoral cyst. There is overall mild mass effect upon the underlying brain parenchyma and slight midline shift to the right. The left calvarial tumor also extends into the overlying subgaleal space, measuring up to 7 mm in thickness. There are smaller metastatic lesions within the right and mid frontal calvarium without epidural or subgaleal extension.