77 years Male (DOB:10/13/1939)Reason: evaluation of brain lesion History: Altered mental statusPROVIDER/ATTENDING NAME: SEJAL PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hemorrhagic mass present in the right parietal lobe measuring 27 x 26 mm axial dimensions. There is associated vasogenic pattern of edema. There are some patchy enhancement associated with this.There is leptomeningeal enhancement present along the right hemisphere. On susceptibility imaging there are punctate foci of signal loss in the right frontal lobe subcortical white matter. There is some vasogenic edema present within the right frontal lobe.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is a hemorrhagic mass present in the right parietal lobe which is concerning for a neoplasm. This patient is reported to have a primary tumor in the esophagus. As a result it is suspicious for metastatic disease.2.There is leptomeningeal disease involving the right hemisphere. Differential considerations include leptomeningeal carcinomatosis and infection with meningitis. Please correlate with patient's clinical history.3.There are multiple microhemorrhages present in the right frontal lobe. These are nonspecific. In the current clinical context they could represent punctate foci of metastatic disease though they could also be a result of leptomeningeal carcinomatosis or meningitis.