48-year-old female with known multiple brain metastases and concern for herniation. Redemonstrated are multiple enhancing brain lesions with associated surrounding edema, some of which abut the dural surface. The largest is again seen in the left frontal lobe just deep to the superior frontal sulcus which measures 2.6 x 2.4 cm (series 1201, image 126). There is some susceptibility abnormality indicating intratumoral hemorrhage. The associated vasogenic edema is marked and causes 1 cm of focal rightward subfalcine herniation. A second relatively large intraparenchymal lesion adjacent to the floor the left middle cranial fossa is more heterogeneously enhancing and has more susceptibility abnormality indicating more intratumoral hemorrhage. This lesion also has associated adjacent vasogenic edema, with complete effacement of the left temporal horn. The associated mass-effect results in asymmetric widening of the left ambient cistern and minimal medial displacement of the left uncus. Midline shift to the right measures 6 mm. There is also partial effacement of the remaining left lateral ventricle and third ventricle is not visualized. The right lateral ventricle is slitlike.Other smaller lesions are present in the right parieto-occipital region, posteromedial right temporal lobe in the periatrial location, and the left cerebellar hemisphere. Smaller lesions are seen in the medial right brachium pontis as well. Even smaller lesions are suggested scattered along the gray-white junction diffusely.There is lobulated mucosal thickening within the maxillary sinuses bilaterally. There are no enhancing lesions involving the calvarium.
Multiple supratentorial and infratentorial enhancing lesions consistent with metastatic disease. The largest is in the left frontal lobe with extensive associated vasogenic edema. There is 6 mm rightward midline shift and findings of early uncal herniation.