55 year old female with metastatic breast cancer who presents with left-sided blurry vision. Rule out metastases disease to the eye or brain. Expansile lytic destructive changes of calvarium consistent with metastatic lesions are again identified. There is significant interval increase in the size of lesions since prior study. There is no apparent epidural spread of tumor into the spinal canal. This can be significantly better visualized on MRI exam. The brain parenchyma remains normal in density and demonstrates no abnormal enhancement of the right parenchymal or the meninges. There is also suggestion of new additional metastatic lesions to the calvarium.Expansile mixed density left frontal bone lesion with significant extension into the right orbit is consistent with fibrous dysplasia is again identified with no interval change.CT of maxillofacial. Significant expansion of right frontal bone in all of its segments and in particular along the floor of the right anterior cranial fossa is noted. The changes extends medially and involves the fovea ethmoidalis and the left frontal bone and is contiguous with fibrous dysplasia changes of sphenoid bone. Significant expansion of the right frontal bone causes elevation of right frontal lobe. Expansile changes of right frontal bone reduces the carinal cephalad axis of the right orbit and applies mass effect on the external ocular musculature and globe. Coronal reformatted images demonstrate these findings with better advantage. There is fibrous dysplasia of left frontal bone along the floor of the anterior cranial fossa. There is mild compromise of the left optic nerve canal and likely the right optic nerve canal secondary to fibrous dysplasia changes at the level of planum sphenoidale. The retro-orbital fat, extraocular musculature and globe remains normal on the left.
1.Increase in the size of lytic destructive metastatic lesions of the calvarium with no apparent extension into the intracranial space.2.No evidence of edema brain parenchyma or abnormal enhancement of the brain or leptomeninges.3.Large fibrous dysplasia of right and to a lesser degree left frontal bones with associated changes of the orbit as detailed above.