Reason: s/p R frontal metastatic malignant fibrous histiocytoma resection, planning for post-op radiation History: N/AAdditional history from EMR: Although the reason above reports a RIGH t frontal lobe tumor, pathology corroborates with a LEFT frontal mass. There is been interval expected evolution of postoperative changes from previous left-sided craniotomy for resection of the previous left frontal lobe hemorrhagic lesion, with interval slight decreased size of the resection cavity. There is a complete peripheral rim of susceptibility relating to chronic hemosiderin deposition, slightly more prominent than prior. There is a minimal surrounding halo of T2 hyperintensity remaining, likely relating to posttreatment changes and residual vasogenic edema. Within limitations of only postcontrast imaging, there is mild peripheral intrinsic T1 hyperintensity likely relating to the postoperative blood products, without significant nodular areas of increased signal.Additional hemorrhagic lesion involving the body the right lateral ventricle abutting the septum pellucidum is essentially no longer appreciated on postcontrast images, although there remains significant susceptibility in this location. Overall, the ventricles appear slightly increased in size likely relate to mild global volume loss. Susceptibility in the right occipital horn dependently has resolved.There are additional right temporal lobe rounded enhancing lesions, the larger of which is located laterally, now measuring 5 x 6 mm. A smaller punctate lesion is seen along the mesial right temporal lobe on 301/73. Punctate susceptibility is seen associated with the medial lesion. Additional punctate foci of susceptibility are seen along the superior left temporal lobe, with the more anterior finding not seen previously and stable posterior focus. There is minimal T1 hypointensity in these locations with previous very subtle enhancement questioned now suggesting treated lesions. The more posterior finding demonstrates punctate enhancement along its periphery on 301/103.There remains a prominent mucosal retention cyst within the left maxillary sinus along the floor.
1. Interval expected evolution from prior left frontal lobe postoperative changes with slight decreased size of hemosiderin stained resection cavity. No evidence of nodular increased signal/enhancement on these postcontrast images to suggest recurrent/residual tumor.2. Previously noted hemorrhagic intraventricular lesion along the right aspect of the septum pellucidum is no longer appreciated on postcontrast images consistent with favorable treatment response.3. Additional right temporal lobe metastases, with slight increased size of the more lateral lateral finding.