81 years, Female, metastatic breast cancer. There is extra-axial enhancing soft tissue along the dorsum sella and posterior aspect of the clivus measuring approximately 8 x 21 x 18 mm in the AP, transverse, and craniocaudal dimensions. The soft tissue lesion abuts the ventral aspect of the pons. No mass effect on the pituitary gland or optic chiasm.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but likely represent mild chronic small vessel ischemic disease and/or posttreatment-related changes. Brain parenchyma is otherwise unremarkable for age. No evidence of acute ischemia or intracranial hemorrhage. No abnormal parenchymal enhancement to suggest intraparenchymal metastatic disease. Major flow-voids are preserved.Multiple small lesions are seen throughout the calvarium are consistent with osseous metastases. Several these lesions violate the inner table of the calvarium without significant intracranial mass effect associated with any of the lesions. Evidence of remote small right medial wall orbital fracture again seen.
1. As seen on recent neck CT from 9/1/2015, there is a dural-based enhancing lesion along the dorsum sella and upper aspect of the clivus measuring 8 x 21 x 18 mm. The lesion fills the left prepontine cistern and abuts the left aspect of the pons with minimal if any local mass effect. This finding is very subtle on prior neck CT in retrospect from 4/3/2015 and does not appear to be present on 10/20/2014. Findings are highly suspicious for enlarging metastasis. No intraparenchymal metastatic lesions are appreciated.2. Numerous osseous metastases throughout the calvarium as seen on prior bone scans. Several of these lesions are seen to violate the inner table without significant associated mass effect on the parenchyma.