Diagnosis: Secondary malignant neoplasm of brainClinical question: renal cell with brain mets, post resection and SRS 7/2014 & whole brain RT 12/2014, compare to last Brain MRI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a ring-enhancing lesion adjacent to the trigone of the left lateral ventricle which currently measures 20 x 20 mm axial dimensions. On the prior exam it measured 22 x 21 mm axial dimensions. The wall thickness of the lesion has decreased from 6 mm to approximately 4 mm. A ring-enhancing right parietal lobe lesion currently measures 7 mm and previously measured the same. These lesions are associated with susceptibility effect. Additional foci of microhemorrhage are present in the left occipital lobe which on prior exams displayed contrast enhancement.The patient is status post right frontal lobe surgery for removal of a mass. There is redemonstration of T2 signal change along the right superior frontal gyrus as well as some blood products but no abnormal enhancement. It appears stable and compared to the previous exam.Normal 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 demonstrate a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.
1.The findings are not old hemorrhagic metastasis of the brain which are relatively stable and compared to the prior exam. There is some indication that similar lesions are a bit smaller on the current exam but not measurably so..2.The patient is status post right frontal lobe surgery for removal of a mass.