Clinical question: CVA. Signs and symptoms: CVA. Unenhanced head CT:Two very small right cerebral cortical strokes are again identified. Images through posterior fossa are otherwise unremarkable and stable.Images through supratentorial space demonstrate a large area of vasogenic edema in the left posterior frontal area is some mass effect on the adjacent cortical sulci. There is no evidence of hemorrhage. Finding is highly suspected for malignancy and recommend further follow up with unenhanced brain MRI. Review of patient's prior PET scan from 5 -- 18 -- 11 indicates hypermetabolic tumor in the left upper lobe which makes the findings on this head CT more suspected for metastatic disease.Very few additional subcortical areas of low attenuation may represent small was ischemic strokes of indeterminate age. Possibility of additional metastatic foci however cannot be entirely excluded.The ventricular system are within normal size and midline is maintained.Calvarium, paranasal sinuses and mastoid air cells are unremarkable. There is evidence of an old blow out fracture of right lamina papyracea. This finding is best appreciated on coronal reformatted image 16.Above findings were reported to Dr. White Nicole #2663 via paging tool at the time of review of exam.
1.New vasogenic edema in the left posterior frontal lobe with focal mass effect. Finding is highly suspected of a metastatic lesion and recommend follow-up with enhanced imaging.2.Minimal small vessel disease.3.Calvarium is intact.