3-month-old with a AT/RT status post resection, VP shunt, and chemotherapy. Increasing morning vomiting. Rule out shunt malfunction, hydrocephalus. The VP shunt catheter enters the skull through the right aspect of the occipital bone. The catheter tip terminates in the left frontal lobe. Position of the catheter is stable from previous studies. Ventricular size is stable from the prior study.In the posterior fossa there is a rounded area of hypoattenuation at the region of the patient's previous tumor resection. This is enlarged since the prior study and raises concern for a cystic lesion exerting mass effect upon the brainstem. Recommend contrast enhanced MRI for better evaluation of this finding.There is increased attenuation in the right transverse and sigmoid sinus consistent with the patient's known dural sinus thrombosis.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. Enlarging, cystic lesion in posterior fossa at site of patient's previous tumor resection. Recommend contrast enhanced MRI for further evaluation. 2. Stable catheter position and ventricular size.3. Stable findings of right transverse and sigmoid sinus thrombosis.These findings were discussed with Dr. Anzoma at 5:40 p.m. 08/19/2008.