40 years Male (DOB:11/17/1975)Reason: tumor progression, infection History: AMS, weaknessPROVIDER/ATTENDING NAME: THOMAS J. KELLY SERVICES ANCILLARY The patient is status post right frontal craniotomy for known anaplastic oligodendroglioma. There is a CSF filled cavity extending from the tumor resection site to be right lateral ventricle. This resection site appears stable.Since the prior exam a nonenhancing heterogeneous signal intensity lesion crossing from the posterior aspect of the tumor bed into the corpus callosum and into the left frontal lobe has mildly enlarged. On T2 imaging it currently measures approximately 82 x 51 mm axial dimensions and previously measured 75 x 46 mm axial dimensions. It is associated with more vasogenic pattern of edema on the current exam relative to the prior exam. On T1-weighted imaging it has heterogeneous signal with some mixed increased and decreased foci of signal. On susceptibility weighted imaging there are multiple punctate foci of signal loss within the lesion. There is decreased cerebral blood flow to this region.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
The patient is status post treatment for a mass located in the right frontal lobe. Since the previous examination a heterogeneous lesion along the posterior aspect of the tubercle bed which crosses the corpus callosum has enlarged. This is suspicious for tumor progression. Radiation necrosis may have a similar appearance.