Diagnosis: Neoplasm related pain (acute) (chronic)Clinical question: 31 y/o with metastatic breast ca, please restage The CSF spaces are appropriate for the patient's stated age with no midline shift. There is diffuse marrow replacement throughout the visualized osseous structures. This was also present on prior exams. There is a particular lesion along the right parietal bone which has some extraosseous extension in the subgaleal tissues as well as the epidural and subdural tissues. The dura is thickened by approximately 3 mm.The right mandibular condyle appears irregular and associated with partially exophytic lesion.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.There is a calvarial metastasis which has associated dural extension and thickening and minimal displacement of the adjacent brain. This was not present on the prior exam. There is no evidence for brain metastases. 2.Diffuse skeletal metastases. Please refer to nuclear medicine exams for further comments.3.There is involvement of the right mandibular head with some destruction of the right head.