Hematemesis [K92.0], Reason for Study: ^Reason: large cell lymphoma with mass at base of skull; eval for tx responsiveness History: see above Brain MRIRedemonstration of right side skull base enhancing mass which involves prevertebral space of C1 arch, right side foramen magnum with encircling right side occipital condyle, right jugular foramen, right hypoglossal canal, right side petrous bone encircling right carotid canal, extending toward right posterior aspect of cavernous sinus most likely through the right inferior petrosal sinus and right side of clivus. The extent of the lesion involvement appear to be unchanged, however, the central portion of the mass shows low signal intensity on T1 and slightly high signal intensity on T2 suggesting possible necrotic changes (previously the mass showed relatively homogeneous enhancement). Ventriculostomy tube inserted through right frontal burr hole.Surgical staple on the right frontal scalp creates significant metallic artifacts.Bilateral optic disc protrusion and prominence of the optic sheath indicating intracranial hypertension are redemonstrated and unchanged. The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses are clear.Unchanged right mastoid fluid collection.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate intra luminal filling defects within the right proximal sigmoid sinus. And the venous flow through the right sigmoid sinus is diminutive and there is no venous flow identified at the level of the right jugular fossa indicating occlusion, unchanged since prior scan. Mid superior sagittal sinus and mid portion of the right transverse sinus show intra luminal filling defects without altering forward flow, unchanged since prior scan.Other major sinuses left transverse sinuses, left sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus are normal. There is no evidence of venous congestive encephalopathy.
1. Interval development of central non enhancing areas of the extensive right skull base mass lesion indicating possible central necrosis. However, overall maximum diameter of the mass does not show any significant interval change.2. Luminal occlusion at the level of the right jugular foramen with diminutive right sigmoid sinus due to intraluminal filling defects, unchanged since prior scan.3. No evidence of venous congestive encephalopathy. 4. Bilateral optic disc and optic sheath changes indicating intracranial hypertension are again seen, unchanged.