Diagnosis: Unspecified malignant neoplasm of skin of scalp and neckClinical question: abnormalities on head CT; evaluate for metastasis vs other etiology such as radiation effect.Signs and Symptoms: angiosarcoma. The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple punctate foci of susceptibility effect present in the subcortical white matter and gray matter of both hemispheres of the brain as well as the cerebellum and brainstem. To some degree these were present on the prior exam but now they are more numerous and the lungs were previously present are somewhat larger. Some of these are associated with contrast enhancement. There are several small foci of contrast enhancement present in the cerebellar hemispheres as well as one in the right occipital lobe and one in the left precentral gyrus. Some of these are associated with adjacent FLAIR signal hyperintensity.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Incidental note is made of partial empty sella.There is a focus of marrow replacement present in the left frontal bone associated with some thinning of the left frontal calvarium and thinning of the adjacent scalp.
1.There are multiple hemorrhagic lesions present throughout the brain compatible with metastases. These have progressed since the prior exam.2.Left frontal calvarial lesion associated with thinning of the adjacent scalp. Please refer to the patient's head CTs for further comments this was also present on the prior exam and does not appear to have changed