50 year-old male with left temporal mass. Evaluate extent of tumor. Rule out lung metastases. CT of the soft tissues of the neck with infusion:Large destructive mass extending from approximate the level of the left submandibular region superiorly with complete involvement of the left infratemporal fossa and right massive involvement of the left orbit with associated extensive bony destruction, significant bony destruction of Petrus bone on the left and with further superior extension into the left anterior and middle cranial fossa and with invagination into the brain parenchyma is again identified. The mass has multiple internal cystic components and demonstrates enhancement. Within the left middle cranial fossa the tumor appears to extend into the left cavernous sinus, left skull base and left sphenoid sinus. Extensive bony destruction of Petrus bone and with post obstructive opacification of mastoid air cells and middle cavity is noted. There is interval increase in the intracranial component of the tumor since prior exam. This in particular appears as multiple expansile cystic in the uppermost visualized portion of the tumor within the intracranial space. Very significant mass effect with resultant significant anterior displacement of the left globe is again identified. The carotid artery is along the dorsal aspect of the tumor and does not appear to be encased however there is significant mass-effect and posterior displacement of the carotid. Extensive postoperative changes of partial mandibulectomy with a metallic prosthesis is again identified. In comparison with the prior examination there is further erosion of the bone specifically at the level of the glenoid cavity which was identified on prior exam to overlap the head of the prosthesis. The no detectable pathologic adenopathy in the neck is seen.CT of brain with infusion:Interval increase in the size of the intracranial component of the tumor in the left anterior and middle cranial fossa and within the left and trigger frontal and left anterior and mid temporal lobe. Extensive bony destruction is again identified involving the left orbit, left Petrus bone, left frontal bone and temporal bone. There is vasogenic edema surrounding the tumor and significant mass-effect and midline shift. This is study is compared with the most recent MRI examination of brain dated 4 -- 15 -- 2009 which demonstrates significant increase in the midline shift and mass-effect. There is also slight interval increase in the size of right lateral ventricle concerning for early onset of hydrocephalus.68 cc of Omnipaque 350 was utilized for the above studies.
Increase in the size of patient's known tumor in particular in its intracranial component and with associated increase in edema, mass effect, mid line shift and right-sided ventriculomegaly.