70 years Male (DOB:4/15/1946)Reason: Eval pineal parenchymal tumor of intermediate grade. S/p RT. S/p bx. Please compare past few MRIs. History: pineal parenchymal tumor.PROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS There is redemonstration of pineal region mass which infiltrates the thalami and is associated with heterogeneous contrast enhancement as well as punctate foci of susceptibility effect. On contrast enhanced imaging currently measures 31 x 27 mm axial dimensions and previously measured 27 x 24 mm axial dimensions. It involves more of the posterior aspect of the left thalamus in the medial aspect of the right thalamus. The tumor also involves the tectal plate and periaqueductal of gray with slightly greater involvement on the current versus the prior exam.There is redemonstration of a focus of encephalomalacia along the right occipital pole. The patient status post right occipital craniotomy.A ventriculostomy tube courses the right frontal lobe into the right lateral ventricle is in stable position. Biventricular diameter at the level of the foramen Monro on coronal imaging is currently 39 mm and was previously 36 mm. Third ventricular diameter is currently 10 mm intervals previously 6 mm. Temporal horns of the lateral ventricles are not substantially different.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. 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.Since the prior exam, the patient's pineal region neoplasm has enlarged and infiltrated more into the thalami and periaqueductal gray.2.Status post ventriculostomy tube placement. The lateral and third ventricles are larger on the current exam when compared to the prior exam.3.Status post right occipital craniotomy.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Small focus of encephalomalacia is present along the right occipital pole.