66-year-old male with a history of lung cancer status post chemoradiation therapy now experiencing left-sided weakness with an abnormal head CT. As partially imaged on the noncontrast CT performed earlier same day, there are multiple ring-enhancing lesions are seen bilaterally within both supratentorial and supratentorial brain, associated with significant adjacent vasogenic edema, most compatible with metastatic disease. The largest of these lesions is located within the right anterior frontal lobe measuring 3.0 x 2.8 cm in transaxial dimensions with local mass effect resulting in 8 mm right to left midline shift. These include susceptibility hypointensity suggesting a hemorrhagic component. Additionally, there is an enhancing focus within the soft tissues of the scalp overlying the left parietal bone measuring up to 14 mm in maximal dimension. There is also a partially imaged, ill-defined focus of enhancement overlying the right mandible.Elsewhere there are scattered foci of susceptibility compatible with microhemorrhage, unchanged when compared to 2/6/2015. There are no large areas of restricted diffusion to suggest an acute territorial infarction. A chronic right orbital medial blowout fracture is again noted. The paranasal sinuses and mastoid air cells are clear.Redemonstrated are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. Again noted is nonspecific left falcine calcification. There is a left frontal developmental venous anomaly partially displaced by mass effect.
1.Multiple ring-enhancing metastases within both temporal tentorial and supratentorial brain resulting in local mass effect and 8 mm right to left midline shift.2.Enhancing abnormality within the soft tissues overlying the left frontal bone and the right mandible suspicious for cutaneous metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.