69 years, Male, mesothelioma, now with hypoglossal nerve route. Evaluate for tumor involvement. There is an enhancing mass involving the left occipital bone including the left occipital condyle, inferior aspect of the clivus, and the left hypoglossal canal. There is a small soft tissue component. Mass measures approximately 2.4 x 5.5 cm in the axial plane, series 2801 image 49, and approximately 3 cm in the craniocaudal dimension, coronal STIR series 1901 image 27. No abnormal enhancement or masses within the brain parenchyma are appreciated. No evidence of acute ischemia or hemorrhage. There is a focus of susceptibility in the right occipital lobe consistent with chronic microhemorrhage. No extra-axial collections. No hydrocephalus. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. There is opacification of the left mastoid air cells. Minimal mucosal thickening is seen involving the paranasal sinuses. No additional lesions within the calvarium within the limits of MRI are appreciated. There is a 15 mm x 4 mm raised skin lesion involving the left frontotemporal scalp.There is mild ptotic appearance of the left posterior tongue. Images of the neck are mildly motion degraded but demonstrate left supraclavicular lymphadenopathy, measuring up to 16 mm in the short axis. Diffuse nodular pleural thickening involving the left hemithorax related to known mesothelioma as well as mediastinal extension of tumor is again seen and better assessed on recent chest CT from 11/12/2015.There is an enhancing lesion measuring 11 x 9 mm involving the left upper sternocleidomastoid muscle, axial post gadolinium series 2301 image 29.There is edema involving the C3 and C4 vertebral bodies along the endplates favored to be degenerative in etiology. Diffuse low T1 marrow signal is seen in the cervical spine, which is nonspecific with no large destructive lesions within the cervical spine are appreciated within the limitations of motion degradation.
1. Osseous metastasis involving the left posterior skull base measuring approximately 2.4 x 5.5 x 3.0 cm with involvement of the left hypoglossal canal.2. There is posterior drooping of the left tongue base compatible with cranial nerve palsy.3. 11 x 9 mm enhancing lesion involving the left upper sternocleidomastoid muscle suspicious for metastasis.4. Metastatic left supraclavicular lymphadenopathy.5. Extensive nodular pleural thickening involving the left hemothorax extending into the mediastinum consistent with known mesothelioma and better assessed on recent chest CT from 11/12/2015.6. No abnormal enhancement or masses within the brain parenchyma.7. 15 x 4 mm raised skin lesion along the left frontotemporal scalp which is nonspecific and can be correlated with direct visualization.