Diagnosis: Melanoma of skin, site unspecified Unspecified psychosisClinical question: pt with new onset confusion - please eval for metastatic diseaseSigns and Symptoms: met melanoma The patient is status post left parietal craniotomy for removal of a lesion in the left parietal lobe since the previous exam from July the lesion located in the left parietal lobe has decreased in size now measures 18 x 16 mm axial dimensions and previously measured 20 x 18 mm axial dimensions. It is associated with blood products and spotty contrast enhancement. The associated vasogenic edema has significantly decreased compared to the July exam.There is redemonstration of a 6 mm enhancing focus along the lateral aspect of the right superior frontal gyrus just anterior to the paracentral lobule which is associated susceptibility effect.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.A hemorrhagic lesion in the left parietal lobe has decreased in size compared to the prior exam. This is known to represent metastatic disease.2.A hemorrhagic lesion in the right superior frontal gyrus is stable compared to the prior exam. This compatible with hemorrhagic metastasis.