70 years Male (DOB:4/15/1946)Reason: eval pineal tumor and flow from 3vc, please include cine flow History: eval pineal tumor and flow from 3vc, please include cine flowPROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG There is a heterogeneous enhancing mass centered in the pineal region and quadrigeminal plate which is associated with narrowing of the aqueduct and ventriculomegaly. This was demonstrated on prior exams. There is associated surrounding T2 signal hyperintensity within the thalami and midbrain. There is associated susceptibility effect within the lesion. The mass itself currently measures 42 x 32 mm axial dimensions and on the 11/24 exam measured 39 x 29 mm axial dimensions. It has a central nonenhancing component on the current exam which was smaller on the prior exam. This nonenhancing component is heterogeneous on T2 and predominantly hypointense on T1. It is associated with susceptibility effect and some T1 hyperintensity suggesting products.The patient is status post right occipital craniotomy.There are multiple foci of susceptibility effect within the lateral ventricles with fluid fluid levels.A ventriculostomy tube is present coursing the right frontal lobe into the right lateral ventricle with a tip adjacent to the septum pellucidum within the frontal horn of the right lateral ventricle. A ventriculostomy tract course of the right frontal lobe into the body of the right lateral ventricle. Biventricular diameter on the current exam is proximal 43 mm prior exams is likely 45 mm. the temporal horns of lateral ventricles remain dilated.There is a right-sided subdural effusion present measuring 8 mm in thickness which was smaller on the prior exam measured 2 mm. There is a mild to moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This has not changed substantially compared the prior examNormal 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.Incidental note is made of a cystic lesion most likely representing a sebaceous cyst along the left occipital scalp tissues. This also present on previous exams and is unchanged. It extends to the skin surface and distorts the skin surface.The exam is somewhat degraded due to motion artifact.CSF flow study demonstrates biphasic flow at the level of foramen of Monro but no flow clearly seen in the aqueduct. A third ventriculostomy is not readily visualized current exam.
1.Quadrigeminal plate and pineal region mass. Since the prior exam the mass has mildly enlarged and is now associated with the central hemorrhagic component. Surrounding edema has also increased relative to the prior exam.2.Ventriculomegaly. A ventriculostomy tube is in place. There are some blood products present within the lateral ventricles. The lateral ventricles are minimally smaller on the current exam compared to the prior exam. There is no convincing evidence for flow through the aqueduct. A third ventriculostomy is not readily seen on this exam.3.A right-sided subdural collection has enlarged compared to the previous exam. There is minimal shift of the septum pellucidum.4.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 