 There are 4 new enhancing lesions which are identified:*a heterogeneously enhancing mass in the posterior left temporal lobe which measures 45 x 38 x 37 mm. This mass is heterogeneous on T1 and T2 sequences with susceptibility artifact consistent with hemorrhage and small areas of necrosis.*a heterogeneously enhancing mass in the left anterior lingual gyrus which measures 15 x 10 x 8 mm. This mass demonstrates susceptibility artifact suggesting hemorrhage.*a heterogeneously enhancing mass in the inferior left frontal lobe which measures 15 x 11 x 11 mm.*5 mm enhancing nodule in the left superior temporal gyrus.There is extensive vasogenic white matter edema in the left cerebral hemisphere. There is mass effect upon the left lateral and third ventricles with approximately 13 mm rightward midline shift. There may be mild entrapment of the right lateral ventricle. There is mild left uncal herniation.Scattered areas of T2 and FLAIR hyperintensity in the subcortical white matter are again noted and likely related to small vessel ischemic disease. There is no diffusion weighted abnormality to suggest infarct. The major intracranial vascular structures enhance normally. No destructive lesions in the calvarium are appreciated.
1.Multiple new enhancing lesions with hemorrhage in the left cerebral hemisphere, compatible with intracranial metastases. Largest hemorrhagic posterior left temporal mass measures 45 x 38 x 37 mm. 2.There is associated vasogenic edema and mass effect with 13 mm rightward midline shift, effacement of the left lateral and third ventricles, and mild left uncal herniation.Findings were discussed with Dr. Salgia by phone at 1536 hrs on 3/18/2015.