Adenoid cystic carcinoma of the left external ear with positive margins treated with TFHX, now with metastatic disease. There are postoperative findings related to left lateral temporal bone resection with diffuse patchy enhancement in the region of the surgical bed. There is also diffuse regional linear dural enhancement, which is likely reactive in nature. However, there are small nodular dural-based enhancing lesions along the anterior left frontal and posterior right frontal convexities, the largest of which measures up to 10 mm, without significant mass-effect upon the brain parenchyma. There is also a nodular enhancing lesion involving the pituitary infundibulum that measures up to 18 mm, with assocated mild vasogenic edema in the adjacent hypothalamus and optic apparatus. In addition, there is a punctate enhancing lesion in the posterior right occipital lobe. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. There appears to be relatively slow flow through the asymmetrically narrow left sigmoid sinus. The orbits are grossly unremarkable.
1. Multiple dural-based lesions, a pituitary infundibular lesion, and a punctate right occipital lobe lesion likely at least in part represent metastatic disease.2. Postoperative findings related to left lateral temporal bone resection with nonspecific diffuse enhancement in the overlying soft tissues.