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  14b (Brain) - Answer: 48-year-old male presents with history of brain tumor

HISTORY: 

This 48-year-old male presents with history of brain tumor. Surgery eight years prior.


(QUIZ ANSWER) THE LESION HAS: 

Increased in size.


CURRENT CASE:

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


COMPARISON CASE:

Comparison MRI from eight months prior.


FINDINGS:

Minimally enhancing soft tissue mass within the right occipital horn measuring 1.4 x 2.1 x 1.7cm is best appreciated on postcontrast axial series, postcontrast coronal series, and precontrast sagittal T1 FLAIR series. In comparison to the MRI of eight months prior, this lesion has increased in size. 

No evidence of leptomeningeal seeding. 

Diffusion-weighted images are without a diffusion restrictive defect. Calvarium is intact. 

Patient is status post right-sided craniotomy and partial temporal lobectomy with resection extending posteriorly to involve the lingual gyrus and floor of the middle fossa. Subtle gyral pattern of enhancement on the tentorial surface of the posterior temporal lobe was present on the earlier study. Compensatory enlargement of the right lateral ventricle right temporal horn was also present on the earlier examination. Ventricular size appears stable. No extra-axial hemorrhage. No obstructive hydrocephalus. 

No abnormal meningeal enhancement. 

No suprasellar masses. 

Diffusion-weighted images may demonstrate mild diffusion restriction associated with the right occipital horn lesion, which appears slightly more conspicuous than on the MRI of eight months prior. 

No masses in the masticator, parapharyngeal or pharyngeal mucosal spaces. 

Porencephaly communicating with the right temporal horn was present on the earlier examination. 

Scattered subcortical hyperintensities may represent gliosis of microangiopathic origin and appears stable in comparison to the MRI of eight months prior. 


CONCLUSION: 

1. Patient is status post right craniotomy, temporal and occipital lobectomy, which was present on the MRI of eight months prior. A minimally enhancing soft tissue mass present in the right occipital horn has increased in size in the interval and may represent recurrent parenchymal neoplasm. 

2. Right temporo-occipital gliosis, encephalomalacia, volume loss was present on the earlier examination and appears stable. 

3. No obstructive hydrocephalus. 

4. No evidence of leptomeningeal seeding. 

5. Gyral pattern of posterior temporal tentorial surface hyperintensity was present on the earlier examination and appears stable. 

6. Ventricular size appears stable in comparison to the MRI of eight months prior.


Discussion

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430577 1572451 10510873 14b (Brain) - Answer: 48-year-old male presents with history of brain tumor /courses/430577/lectures/10510873 true native_comments
430577 1572451 10510873 14b (Brain) - Answer: 48-year-old male presents with history of brain tumor /courses/430577/lectures/10510873 true text

HISTORY: 

This 48-year-old male presents with history of brain tumor. Surgery eight years prior.


(QUIZ ANSWER) THE LESION HAS: 

Increased in size.


CURRENT CASE:

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


COMPARISON CASE:

Comparison MRI from eight months prior.


FINDINGS:

Minimally enhancing soft tissue mass within the right occipital horn measuring 1.4 x 2.1 x 1.7cm is best appreciated on postcontrast axial series, postcontrast coronal series, and precontrast sagittal T1 FLAIR series. In comparison to the MRI of eight months prior, this lesion has increased in size. 

No evidence of leptomeningeal seeding. 

Diffusion-weighted images are without a diffusion restrictive defect. Calvarium is intact. 

Patient is status post right-sided craniotomy and partial temporal lobectomy with resection extending posteriorly to involve the lingual gyrus and floor of the middle fossa. Subtle gyral pattern of enhancement on the tentorial surface of the posterior temporal lobe was present on the earlier study. Compensatory enlargement of the right lateral ventricle right temporal horn was also present on the earlier examination. Ventricular size appears stable. No extra-axial hemorrhage. No obstructive hydrocephalus. 

No abnormal meningeal enhancement. 

No suprasellar masses. 

Diffusion-weighted images may demonstrate mild diffusion restriction associated with the right occipital horn lesion, which appears slightly more conspicuous than on the MRI of eight months prior. 

No masses in the masticator, parapharyngeal or pharyngeal mucosal spaces. 

Porencephaly communicating with the right temporal horn was present on the earlier examination. 

Scattered subcortical hyperintensities may represent gliosis of microangiopathic origin and appears stable in comparison to the MRI of eight months prior. 


CONCLUSION: 

1. Patient is status post right craniotomy, temporal and occipital lobectomy, which was present on the MRI of eight months prior. A minimally enhancing soft tissue mass present in the right occipital horn has increased in size in the interval and may represent recurrent parenchymal neoplasm. 

2. Right temporo-occipital gliosis, encephalomalacia, volume loss was present on the earlier examination and appears stable. 

3. No obstructive hydrocephalus. 

4. No evidence of leptomeningeal seeding. 

5. Gyral pattern of posterior temporal tentorial surface hyperintensity was present on the earlier examination and appears stable. 

6. Ventricular size appears stable in comparison to the MRI of eight months prior.