56-year-old male with a history of squamous cell carcinoma of the nasopharynx status post surgery and chemoradiation therapy with probable metastatic disease to the brain. Evaluate for shift. There is a heterogeneous soft tissue density in the right ethmoid sinus with associated destruction and invasion through the overlying right lamina papyracea consistent with the patient's history of sinonasal squamous cell carcinoma. Additionally, there is an air-fluid level in the left frontal sinus and left ethmoid sinus mucosal thickening.There is a 3-cm isodense mass in the right frontal lobe (10; series 4) with extensive surrounding vasogenic edema highly suspicious for metastatic disease, previously 2 cm on outside MRI examination, significantly enlarged. Additionally, note is made of a 9 x 13 mm focus of hyperdensity in the posterior aspect of the aforementioned mass which likely represents hemorrhage adjacent to the tumor. There is associated local mass-effect with a 6-mm local leftward midline shift of the inferior right frontal cortex. There is no evidence of extra-axial fluid collection. There is preservation of the gray-white matter interface. There is no evidence of acute territorial infarct. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells are within normal limits.
1. 3 cm mass in the right frontal lobe with extensive surrounding vasogenic edema consistent with intracranial extension of tumor from the ethmoid air cells. There is a hyperdense focus in the posterior aspect of the aforementioned mass which likely represents hemorrhage. There is associated local mass-effect with a focal leftward midline shift of the inferior right frontal cortex. 2. There is a heterogeneous soft tissue density in the right ethmoid sinus with associated destruction and invasion through the overlying right lamina papyracea consistent with the patient's history of sinonasal squamous cell carcinoma. Additionally, there is an air-fluid level in the left frontal sinus and left ethmoid sinus mucosal thickening.