Reason: Restaging metastatic breast cancer to CNS History: Restaging The patient is status post left-sided frontal craniotomy. There is redemonstration of encephalomalacia in the left frontal lobe without evidence for local recurrence. There are punctate foci of susceptibility present in the tumor bed.Several punctate foci of susceptibility are present in the right periventricular white matter and right superior and parietal lobuleThere is a 5 x 7 mm enhancing nodule in the medial left frontal lobe at the anterior aspect of the superior frontal gyrus just anterior to the cingulate sulcus which previously measured 5 x 4 mm.  Another nodule measuring 5 x 3 mm is present along the left inferior frontal gyrus along the pars triangularis.A previously described enhancing nodule at the lateral aspect of the left precentral gyrus is not readily seen on the current exam.A previously described enhancing nodule in the left superior temporal gyrus is not readily identified on the current exam.A punctate questionably enhancing focus is present at the medial aspect of the right superior frontal gyrus anteriorly which is of uncertain significance.A previously described punctate lesion in the left basal ganglia is not readily identified on the current examThere is redemonstration of a microhemorrhage surface of the left thalamus superiorlyNormal 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 demonstrate minor opacities in the right mastoid air cells. The visualized portions of the orbits are intact.
1.Since the prior exam nodules in the left basal ganglia left superior temporal gyrus and the left precentral gyrus are not readily identified on the current exam.2.Since the prior exam nodules in the left inferior frontal gyrus and left superior frontal gyrus are slightly larger3.status post left frontal craniotomy for removal of a left frontal lobe mass