52-year-old man with history of renal cell carcinoma with brain metastases status post craniotomy and resection on 9/16/2015 now with right facial swelling. Evaluate for postoperative changes or infection. There are postoperative findings related to right frontotemporal craniotomy. There is a heterogeneous subdural collection underlying the craniotomy site and in the subgaleal space. The fluid collections demonstrate diffusion restriction and there is avid linear enhancement along the resection cavity, increased when compared to the prior MRI. There is extensive surrounding edema results in mild mass effect, right lateral ventricle effacement and approximately 7 mm of leftward midline shift are unchanged. The basal cisterns are patent. There is also been an increase in the collection overlying the scalp. There is interval increase in size of two subcentimeter cerebellar lesions. The focus in the right cerebellar hemisphere is associated with susceptibility artifact. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable.
1.Postoperative findings related to right frontal lobe metastasis resection with extensive enhancement in the surgical bed and overlying scalp suggests a wound infection with possible abscess formation.2.Interval increase in size of the subcentimeter cerebellar metastases.