Known history of brain mets status post WBRT in 4/2014. Baseline exam. There has been overall interval increase in size of the enhancing component of numerous supratentorial and infratentorial masses as well as the associated vasogenic edema. For example, a heterogeneously enhancing mass in the right medial temporal lobe measures up to approximately 30 mm, previously up to 15 mm, a partially cystic or necrotic mass in the right superior frontal gyrus measures up to approximately 20 mm, previously 15 mm, and an enhancing tumor in the right cerebellar hemisphere measures up to approximately 10 mm, previously 5 mm. Many of the lesions contain susceptibility effect, which may represent hemorrhage or calcifications. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and imaged portions of the cervical spine are diffusely heterogeneous. There are bilateral lens implants.
1. Interval progression of numerous supratentorial and infratentorial brain metastases with associated vasogenic edema, but no midline shift. 2. Extensive osseous metastases.Discussed with Dr. Hoffman on 1/21/2015 11 AM.