Clinical question: Lung cancer with bony metastases, status post chemo, evaluate disease a status. Signs and symptoms: Lung cancer. Nonenhanced head CT:Patient refused injection of contrast after partial externalization of contrast from the first trial.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Periventricular and subcortical low attenuation of bihemispheric white matter is suspected for mild small vessel ischemic disease of indeterminate age. No evidence of the mass on these non-infused study.Recommend either repeat CT exam with intravenous contrast or an enhanced MRI to exclude possibility of small metastatic disease.Calvarium is intact. Limited view of orbits are unremarkable.Lasted vessels limited cavities are pneumatized are unremarkable.Extensive chronic sinus disease of right maxillary sinus, minimally left maxillary sinus and minimally of bilateral ethmoid sinuses and the frontal signs.
1.No evidence of metastatic disease to the brain or the calvarium on these non-infused study.2.Minimal small vessel disease of indeterminate age.