71 years Male (DOB:11/14/1944)Reason: patient with a history of met urothelial cancer, new right lesion in the right frontal cranial fossa, and new complaints of unilateral strength and functional problems. Please assess for disease progression History: met urothelial cancerPROVIDER/ATTENDING NAME: PETER H O'DONNELL PETER H O'DONNELL There is a large irregularly-shaped peripherally enhancing mass located in the right frontal lobe and measuring 51 x 50 mm axial dimensions. It is high signal on T2 and intermediate signal on FLAIR and low signal on diffusion imaging and T1 imaging. Signal intensity on T1 is slightly higher than spinal fluid. The enhancing component is dark on susceptibility imaging. There are irregularly-shaped serpiginous flow-voids on susceptibility imaging along the inferior and superior aspect of the lesion suggesting adjacent microvascular. There is associated mass effect with midline shift. There is a moderate degree of vasogenic type edema associated with this. The septum pellucidum is shifted approximately 9 mm to the left of midline. The uncus is shifted medially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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. The eyeball lenses are thin.
There is a large mass centered in the right frontal lobe which is concerning for neoplasm. It is associated with mass effect and midline shift and subfalcine herniation. Given the patient's clinical history of primary tumor elsewhere metastases is a significant consideration. A primary brain tumor is alternative explanation. Infection is less likely based on its imaging characteristics.