Clinical question: GBM. Signs and symptoms: Injury. Pre and post enhanced brain MRI:Examination demonstrates a large focus of vasogenic edema in the right hemisphere with significant extension into the corpus callosum consistent with patient's known peritumoral edema. There are small foci of susceptibility changes in the corpus callosum consistent with hemorrhage with subtle interval increase since prior exam.Within the edema and there are multiple noncontiguous foci of necrotic rim-enhancing tumor within the right hemisphere and the corpus callosum. The largest focus of tumor enhancement is in the right frontal lobe measuring maximum of 51 x 38 mm in transaxial dimensions which is significantly larger than prior study.Multiple loculated necrotic enhancing tumor in the corpus callosum with mild extension into the left hemisphere demonstrate mild interval increased necrosis without significant change since prior study. Note should be made that very irregular shape of tumor makes precise assessment difficult.Constellation of findings results in mild deviation of midline to the left of approximately 8mm at the level of corpus callosum/foramen of Monro with interval progression. Minimal interval increased size of mildly dilated left lateral ventricle is also noted.There is no detectable new foci of parenchymal signal abnormality or parenchymal/meningeal enhancement.
1.Interval significant increased size of a right frontal lobe glioblastoma since prior exam.2.Multiple loculated enhancing foci of tumor in the corpus callosum and with extension into the left hemisphere demonstrate no significant change in their size.3.Constellation of findings results in 8 mm leftward of midline which is new since prior exam and there is minimal interval increased size of left lateral ventricle.