 CT of the maxillofacial region without the infusion:Examination demonstrates a large destructive bony metastasis of the right frontal bone involving the floor of the right anterior cranial fossa and with a significant extracranial component which measures 80-mm in AP axis and 40-mm in transverse axis (axial image 6 of 50). Although not as well-visualized on this exam as it was noted on MRI of brain dated 10 -- 10 -- 2009 there is a large intracranial extension of tumor into the right anterior and middle cranial fossas. Extensive destructive changes of the frontal bone along the floor of the right anterior cranial fossa, lateral orbital ridge and greater wing of the sphenoid on the right is noted. There is a large extraconal retro-orbital spread of tumor which does not extend to the apex of the orbit. This component of the mass measures 53-mm times 26-mm in transaxial dimensions (axial image 50). There is significant mass effect on the retro-orbital content, including lateral rectus, superior rectus, right optic nerve and globe which is significantly deformed. There is also suggestion of extension of tumor into the right frontal sinus. This component of tumor within the right frontal sinus may be a second smaller metastatic lesion. There is no apparent involvement of the cavernous sinus. No extension of tumor into the apex of the orbit, no involvement of the lamina papyracea. The extracranial component of the tumor appears to extend inferiorly into the right infratemporal fossa. The paranasal sinuses are well pneumatized and demonstrate only minimal opacification of right anterior ethmoid air cells. Mastoid air cells and middle ear cavities are unremarkable.CT of the soft tissues of the neck with infusion:Redemonstration of large destructive mass involving the right frontal bone with extension into the right anterior cranial fossa and right middle cranial fossa. There is extension of the mass into the right orbit with significant mass-effect on the retro-orbital content. No evidence of involvement of the cavernous sinus is detected. Large extracranial soft tissue component the tumor in the right frontal and temporal region is also present. There is evidence of edema in the right frontal lobe.Images through the skull base and clinic cavernous sinuses are unremarkable otherwise. Paranasal sinuses and mastoid air cells are well pneumatized. The small amount of tumor within the right frontal sinus laterally is also noted.Images through the neck demonstrate no evidence of pathologic adenopathy. The vasculature of the neck remains intact. The thyroid gland is within normal limits. Bony structures of the area of exam are otherwise negative for any additional metastatic lesions.Images through the apices of the lungs demonstrate extensive emphysematous changes and multiple large emphysematous bulla of the right lung apex. No definite metastatic lesion to the lung is detected. No definitive mediastinal lymph nodes.
1.Large destructive mass involving the right frontal bone along the floor of right anterior cranial fossa with extension into the right orbit, right frontal sinus, right anterior and middle cranial fossas, right frontal temporal extracranial region and right infratemporal fossa. Please see above detailed report.2.Paranasal sinuses are well pneumatized. Please see above comments.3.CT of soft tissues of the neck demonstrate intense enhancement of metastatic lesion to the right frontal bone with extensive intracranial, retro-orbital and extracranial extent as detailed above.4.No evidence of metastatic osseous lesions in other regions.5.No areas of pathologic adenopathy in the neck.  