Stage IV lung adenocarcinoma with brain metastasis. There are postoperative findings related to resection of a left occipital mass with decrease in size of the heterogeneously enhancing mass with areas of susceptibility effect along the margins of the resection cavity. There is also decreased confluent T2 hyperintensity surrounding the resection cavity, which may represent residual vasogenic edema. The ventricles are unchanged in size and configuration. There is an unchanged peripherally enhancing lesion in the right orbitofrontal region, which measures up to 14 mm and an unchanged punctate enhancing lesion in the right postcentral gyrus. However, there is a new punctate enhancing lesion in the left middle frontal gyrus. There is no midline shift or herniation. There are multiple new punctate foci of restricted diffusion in the bilateral cerebral hemispheres and right cerebellar hemisphere with corresponding high T2 signal. Aside from the expected postoperative findings, the skull and extracranial structures are unremarkable.
1. Postoperative findings in the left occipital lobe with decrease in size of the lesion in the resection cavity and associated surrounding vasogenic edema. 2. Unchanged right orbitofrontal and right postcentral gyrus metastases.3. New punctate lesion in the left middle frontal gyrus likely represents a metastasis.4. Multiple punctate foci of restricted diffusion in the bilateral cerebral hemispheres and right cerebellar hemisphere likely represent recent infarcts. Discussed with Dr. Luke at 11:20 AM on 10/16/15.