History of breast cancer, presents with neck pain and spinal tenderness rule out brain metastasis and cord compression. Brain: There is a 5 mm wide enhancing lesion in the right subcortical occipital lobe and a 4 mm wide enhancing lesion in the left posterior parietal lobe. There is an enhancing lesion in the left frontal bone with associated thin dural and periosteal enhancement. There is also an enhancing lesion involving the right occipital bone, in the region of the condyle, with mild dural extension. There are patchy and scattered periventricular and subcortical white matter hyperintensities without associated enhancement, which are nonspecific. The ventricles and basal cisterns are normal in size and configuration, including cavum septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small amount of fluid in the posterior ethmoid sinuses, posterior nasal cavity, and nasopharynx, likely related to intubation. The orbits are grossly unremarkable.Spine: There is considerable thoracic dextroscoliosis and lumbar levoscoliosis. There is multilevel degenerative spondylosis in the cervical spine and lower lumbar spine without significant narrowing of the spinal canal. The spinal cord displays normal signal characteristics. There are multiple osseous metastatic lesions scattered throughout much of the spine, without discernible epidural extension or loss of vertebral body heights. There is a moderate right pleural effusion and scattered lung opacities. There is also extensive mediastinal and hilar lymphadenopathy. There is trace ascites. There are numerous lesions in the liver.
1. Subcentimeter metastases in the right occipital and left parietal lobes. 2. Skull metastasis with dural extension.3. Extensive osseous metastatic lesions throughout much of the spine, without spinal cord compression or apparent vertebral body collapse.4. Considerable thoracic dextroscoliosis and lumbar levoscoliosis and multilevel degenerative spondylosis in the cervical spine and lower lumbar spine without significant narrowing of the spinal canal. 5. Right pleural effusion and scattered lung opacities, as well as mediastinal and hilar lymphadenopathy, which represent metastases. Please refer to the recent CT chest report for additional details.6. Partially imaged multiple metastatic lesions in the liver and trace ascites. Please refer to recent CT abdomen from for additional details. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.