 There are numerous enhancing intracranial lesions predominantly near the gray-white matter junction suspicious for metastatic disease. Majority of these lesions demonstrate some hemorrhagic component similar to prior CT with surrounding vasogenic edema. The largest hemorrhagic lesion is centered in the right parietal lobe measuring 3.1 x 2.7 cm. Additionally, there is a lesion centered in the atrium of the right lateral ventricle measuring 1.9 x 1.7 cm. A calvarial lesion near the skull vertex with subgaleal and epidural extension measures 1.8 x 4.1 cm (cc by AP). This lesion also appears to invade the adjacent superior sagittal sinus. There is no diffusion restriction to suggest acute ischemia. There is mucosal thickening of the left maxillary sinus with an air-fluid level.
1. Numerous supratentorial and infratentorial enhancing lesions as well as a right intraventricular lesion are suspicious for metastatic disease. Majority of these lesions demonstrate at least some degree of hemorrhage.2. There is a calvarial lesion near the skull vertex with subgaleal and epidural extension as well as invasion of the adjacent superior sagittal sinus.3. Left maxillary sinus disease.