Diagnosis: Malignant neoplasm of breast (female), unspecified site. Encounter for long-term (current) use of other medications. Shortness of breath.Clinical question: metastatic breast cancer s/p 6 cycles of chemo please assess response to therapy and compare to previous imaging The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior examination the mass centered in the left superior frontal gyrus posteriorly and its junction with the precentral gyrus has decreased in size. There is associated susceptibility effect.There are FLAIR hyperintense lesions on the prior exam which are associated with contrast enhancement located within the cerebellar hemispheres, right temporal lobe and along the left cingulate gyrus and left middle frontal gyrus which are not readily appreciated on the current exam.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 opacified. The visualized portions of the orbits are intact.
1.The patient refused portions of the exam including postcontrast imaging. As a result many of the lesions identified on postcontrast imaging cannot be adequately evaluated. 2.Since the prior examination the left frontal lobe mass appears to decreased in size. Definitive measurements cannot be made due to lack of contrast enhancement.3. Lesions previously noted in the cerebellum, right temporal lobe, left cingulate gyrus and left middle frontal gyrus cannot be identified on the current exam and cannot be adequately evaluated on the current exam due to lack of contrast enhanced sequence. These particular lesions had FLAIR signal abnormality in the prior exam but currently are not readily identified. It is suspected that they have at least decreased in size.4.Opacification of mastoid air cells. This is a nonspecific finding but could be due to an inflammatory reaction no obstructive lesions appreciated in the nasopharynx is a potential cause. Please correlate with physical findings on clinical exam.