Metastatic melanoma. On immunotherapy. There is a superficially located, lobulated, heterogeneous mass measuring up to 2.9 cm involving the medial aspect of the posterior right parietal lobe. It shows intense, heterogeneous contrast enhancement, which also extends into the adjacent sulci. The mass and the adjacent sulci show susceptibility effect reflecting the presence of blood products. This is associated with moderate surrounding white-matter T2-hyperintensity as well as mass-effect, on the overlying sulci and the adjacent posterior right lateral ventricle, and trace midline shift. This is new since prior examinations from October 20, 2015. There is no other space-occupying or contrast-enhancing brain lesion. A tiny subcortical focus of susceptibility effect in the left parietal lobe is not associated with contrast enhancement or edema. There is no generalized meningeal abnormal contrast enhancement. There is no acute infarct. There is encephalomalacia involving the inferior medial frontal lobes (gyri recti), which probably represents previous traumatic injury. There is no hydrocephalus or brain herniation. There is trace mucosal thickening in the maxillary and ethmoid sinuses. There has been a right eye lens replacement. There is a partially empty sella, There is no destructive skull lesion. A 7 mm midline cystic lesion involving the nasopharyngeal mucosa is probably an incidental Thornwaldt cyst.
1.New, since October 2015, right parietal mass with vasogenic edema and mild mass-effect, compatible with hemorrhagic brain metastasis. Contrast enhancement and susceptibility effect in the adjacent sulci are likely related to the hemorrhage and venous engorgement. 2.No other brain mass or diffuse leptomeningeal contrast enhancement. A tiny subcortical focus of susceptibility effect in the left parietal lobe with no associated contrast enhancement or edema likely reflects an incidental prior microhemorrhage.3.Inferior frontal encephalomalacia most likely from prior traumatic injury.