58-year-old male s/p dural atypical mening resection. Assess for infection There are postoperative changes related to recent meningioma resection in the right parietal region. At the site of the more superiorly resected tumor, what appears to be a fluid collection is seen which abuts the superior sagittal sinus and falx and shows rim enhancement. This collection is slightly larger than was previously seen. There is a mild restricted diffusion along the margin of the cavity, although this is decreased from prior study, and centrally within the cavity, there is no restricted diffusion. Generalized dural thickening along the right parietal and occipital lobes is similar to prior exams. Adjacent to the dura, there is a patchy pattern of ill-defined parenchymal or brain surface enhancement (see image 211, series 1301) which appears increased from the immediate prior study on 6/5/2015, but when compared to older exams in 2013 and 2014, is actually unchanged. Similar though much less extensive enhancement is seen along the left surface of the parietal lobe as well, also unchanged from prior study. The T2 signal abnormality within the brain parenchyma surrounding all of these areas is similar to prior study. There are no other intracranial lesions identified. The remaining brain parenchyma is otherwise unremarkable. No intraparenchymal hemorrhage is identified.
1. Redemonstration of postoperative findings including evidence of recent resection of two meningiomas from the right parietal region. 2. A rim-enhancing collection at the site of the superiorly resected cavity has increased in size. The margin of this cavity demonstrates some restricted diffusion which is reduced from prior study, however there is no restricted diffusion centrally within the cavity. This could simply represent a sterile postoperative collection. Although the possibility of superimposed infection cannot be excluded, the lack of any edema within the surrounding brain parenchyma argues against this. 3. Generalized dural thickening along the right parietal and occipital lobes is within expected limits given the recent meningioma resection. Ill-defined patchy surface enhancement in the right parietal and occipital lobes and the left parietal lobe as well is also stable dating back several years. This is favored to represent radiation related change or an inflammatory process. 