Clinical question: Status post brain tumor resection. Signs and symptoms: Status post brain tumor resection. Pre- and post enhanced brain MRI:Indication is status post left posterior temporal-frontoparietal craniotomy with expected postoperative changes.There is a surgical resection cavity at the site of removed tumor in the left frontal lobe measuring approximately 32 x 37 mm in transaxial dimensions. There is serosanguineous fluid as well as a small amount of air within the surgical cavity which is within expected postoperative finding. Very extensive surrounding vasogenic edema demonstrate no significant change since prior exam.On post enhanced images there is an ill-defined focus of enhancement along the anterior and superior aspect of surgical cavity measuring 10 x 20 mm in transaxial dimensions (axial post enhanced series 1001 image 20) and approximately 14 x 13 mm size measured on sagittal post enhanced series 1/1/2001 image 9. Region of enhancement is believed to represent a focus of residual tumor and further follow-up is recommended.Increased mass effect on the left results in rightward deviation of midline of approximately 4 mm which has a slightly decreased since prior exam. The ventricular system however remain within normal size.Multiple additional necrotic rim enhancing metastatic lesions in bilateral cerebral hemispheres and right cerebellum are again identified without significant change since prior exam from 6-5-15.
1.Expected postoperative changes of a left-sided craniotomy for removal of tumor as detailed.2.Focus of enhancement along the anterior superior aspect of surgical cavity measuring at 10 x 20 mm in transaxial and 14 x 13 mm on sagittal post enhanced images is highly suspected of residual tumor.3.Slight interval decreased rightward deviation of the midline since prior exam and with stable normal size of ventricles.4.Stable multiple bilateral hemispheric and right cerebellar metastatic lesion since prior exam.5.Extensive vasogenic edema in bilateral hemispheres (left greater than right) remains fairly similar to preoperative study.