Clinical question: rule out METs. Signs and symptoms: Right eye pain and vision loss. Examination demonstrates a large destructive bony metastasis of the right frontal bone involving the floor of the right anterior cranial fossa and with a significant extracranial component which measures 80-mm in AP axis and 40-mm in transverse axis (axial image 6 of 50). Although not as well-visualized on this exam as it was noted on MRI of brain dated 10 -- 10 -- 2009 there is a large intracranial extension of tumor into the right anterior and middle cranial fossas. Extensive destructive changes of the frontal bone along the floor of the right anterior cranial fossa, lateral orbital ridge and greater wing of the sphenoid on the right is noted. There is a large extraconal retro-orbital spread of tumor which does not extend to the apex of the orbit. This component of the mass measures 53-mm times 26-mm in transaxial dimensions (axial image 50). There is significant mass effect on the retro-orbital content, including lateral rectus, superior rectus, right optic nerve and globe which is significantly deformed. There is also suggestion of extension of tumor into the right frontal sinus. This component of tumor within the right frontal sinus may be a second smaller metastatic lesion. There is no apparent involvement of the cavernous sinus. No extension of tumor into the apex of the orbit, no involvement of the lamina papyracea. The extracranial component of the tumor appears to extend inferiorly into the right infratemporal fossa. The paranasal sinuses are well pneumatized and demonstrate only minimal opacification of right anterior ethmoid air cells. Mastoid air cells and middle ear cavities are unremarkable.
1.Large destructive mass involving the right frontal bone along the floor of right anterior cranial fossa with extension into the right orbit, right frontal sinus, right anterior and middle cranial fossas, right frontal temporal extracranial region and right infratemporal fossa. Please see above detailed report.2.Paranasal sinuses are well pneumatized. Please see above comments.