Invasive rectal adenocarcinoma with acute encephalopathy. Rule out brain metastasis or infarct. The study is significantly limited by patient motion.Brain: There is a centrally T1 and T2 hyperintense lesion in the right frontal middle gyrus that measures up to 1.7 cm, with thin peripheral susceptibility effect and enhancement. There surrounding vasogenic edema, but no midline shift or herniation. There is apparent patchy restricted diffusion in the bilateral thalami and midbrain without corresponding abnormalities on other sequences. There are numerous punctate foci of susceptibility effect scattered in the bilateral cerebral hemispheres. There are patchy areas of cerebral and pontine white matter T2 hyperintensity. This is moderate diffuse cerebral volume loss. The major cerebral flow voids are intact. There is mild mucosal thickening in the ethmoid sinuses. There is fluid within the mastoid air cells bilaterally. There are bilateral lens implants. There is a subcentimeter left parietal bone hemangioma.Neck: There is T1 and T2 hyperintense lesion in the right aspect of the lower cervical esophagus, which measures up to 2.8 cm in length and 1.1 cm in width. There is also a prominent right supraclavicular lymph node that measures 9 x 14 mm in axial cross-section. Otherwise, there is no evidence of significant cervical lymphadenopathy or other neck soft tissue mass. The parotid glands are mildly prominent diffusely. The submandibular glands are unremarkable. The trachea appears to be intact. There is multilevel degenerative cervical spondylosis.
The examination is significantly limited by patient motion.Brain:1.A cystic right frontal lesion with surrounding vasogenic edema likely represents a metastasis with hemorrhage versus less likely an abscess in this clinical setting. 2.Numerous foci of punctate hemorrhage scattered in the bilateral cerebral hemispheres may represent cerebral amyloid angiopathy.3.Chronic cerebral and pontine chronic microvascular ischemic disease and diffuse cerebral volume loss. Apparent patchy restricted diffusion in the bilateral thalami and midbrain without corresponding abnormalities on other sequences likely represents artifact rather than acute infarction.4.The lesion within the wall of the right lower cervical esophagus may represent a subacute hematoma or hemorrhagic tumor, although the images are markedly limited by patient motion and lack of dedicated sequences with intravenous contrast.5. Nonspecific prominent right supraclavicular lymph node.6. Nonspecific fluid within the mastoid air cells bilaterally.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.