 There are 3 discrete intra-axial enhancing metastases. There is an enhancing mass with central susceptibility effect in the right cerebellar hemisphere measuring 36 x 19 mm with moderate ischemic edema and mass effect on the fourth ventricle and mild mass effect in the posterior fossa. There is an second enhancing rounded mass in the left temporal lobe measuring 17 x 17 mm with extensive surrounding vasogenic edema and regional mass effect with sulcal effacement. There is a third rounded enhancing lesion in the left thalamus measuring up to 6 5-mm with mild surrounding this lytic edema.There is minimal shift of the midline to the right measuring up to 2 mm. There is no uncal, transtentorial or cerebellar tonsillar herniation. There are superimposed nonspecific T2 white matter changes likely representing mild chronic microvascular ischemic changes. There is no acute infarct. There is no hydrocephalus. The osseous marrow signal is heterogeneous without a dominant focal lesion.
1.Three distinct intra-axial metastases involving the right cerebellar hemisphere, left temporal lobe, and thalamus. 2.Largest mass in the right cerebellar hemisphere appears to have small foci of internal hemorrhage, and contributes to mild mass effect in the posterior fossa and narrowing of the fourth ventricle without hydrocephalus. 3.Minimal midline shift to the right.4.No acute infarct. 5.Mild chronic microvascular ischemic changes.Findings were discussed with resident Dr. Abdulrahman Dia from Internal Medicine at 10:45 AM today over the telephone.