Diagnosis: Secondary malignant neoplasm of brainClinical question: cystic brain mets (breast primary) s/p drain placementSigns and Symptoms: eval for extent of disease; for study protocol (please see comments)Comments: Prior surgery: Rickham catheter placement into the L frontoparietal and R temporal lesions on 10/15/15 A ring-enhancing fluid collection present in the left frontal lobe measures 32 x 47 mm axial dimensions and 36 x 36 mm coronal dimensions. On the prior exam it measured 36 x 36 mm coronal dimensions and 35 x 45 mm axial dimensions. The right frontal lobe ring-enhancing lesion measures 8 mm x 9 mm and previously measured 8 mm x 9 mm. A right posterior temporal lobe lesion which is irregularly shaped currently measures 39 x 28 mm axial dimensions and previously measured 45 x 30 mm axial dimensions. This temporal lobe ring-enhancing lesion measures 29 x 14 mm coronal dimensions on the current exam and 39 23-mm coronal dimensions on the prior exam.There is no associated diffusion restriction within these fluid collections. Fluid collections have high signal on T2 and FLAIR imaging within them. There is surrounding halo of edema with each of these ring-enhancing lesions.The patient is status post catheter placement in the left frontal lobe cystic lesion as well as the right temporal lobe lesion through adjacent burr holes.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.
1.Since prior exam a right temporal lobe ring-enhancing lesion has decreased in size. The left frontal lobe lesion in the right frontal lobe lesion remains stable in overall dimensions.2.The patient is status post catheter placement in the left frontal lobe cystic lesion as well as the right temporal lobe lesion through adjacent burr holes.