Malignant neoplasm of breast (female), unspecified site. Secondary malignant neoplasm of brain and spinal cord(198.3) Malignant neoplasm of breast (female), unspecified site Secondary malignant neoplasm of brain and spinal cord Since the prior exam patient has undergone left-sided suboccipital craniotomy. There are blood products present within the left cerebellar hemisphere along the left inferior semilunar lobule. One focus of heterogeneous signal with surrounding signal loss and susceptibility artifact measures 19 x 13 mm and is associated with T1 signal hyperintensity and heterogenous T2 signal suggestive of evolving blood products. Another hemorrhagic focus located at the prior tumor bed is mainly susceptibility effect. There is associated T2 and FLAIR signal hyperintensity throughout most of the left cerebellar hemisphere and cerebellar vermis. There is associated mass effect with compression of the fourth ventricle and displacement of the brainstem anteriorly.There is contrast enhancement present along the left cerebellar hemisphere including the area of the prior lesion in the left inferior semilunare lobule and also along the surgical tract in the left cerebellar hemisphere.There is a 7 x 7 mm axial dimension lesion in the right temporal lobe along the superior temporal lobe gyrus which has not changed in size when compared to the April 2015 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 demonstrate air fluid levels in the sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Status post left cerebellar surgery with associated contrast enhancement and blood products at the surgical site. On the basis of this exam alone, it is not clear whether this represents residual tumor, recurrent tumor, inflammatory reaction to surgery with scar formation or a combination of this.2.There is mass effect in the left cerebellar hemisphere which appears to have increased since the preoperative exams.3.A right temporal lobe mass measuring 7 mm is stable when compared to the prior exam.