MRI -- My radiation oncologist is changing my scan interval to 4 months. Most recent treatment was March 2019.
Clavicle -- My orthopedic surgeon removed all restrictions he had on using my arm/shoulder.
(At the time of the clavicle break, the report on 12/20 said, "Acute comminuted fracture of the right mid clavicle with butterfly fragment and 2 shaft width displacement and angulation causing skin tenting.")
MR BRAIN WITH AND WITHOUT CONTRAST : 3/17/2020 3:20 PM
CLINICAL HISTORY: Brain neoplasm. Follow-up for brain metastases from melanoma. Additional clinical history from apex: NRAS G12A mutation melanoma of the left neck. Metastatic disease diagnosed in 2010 with lung and brain metastases status post multiple resections and multiple courses of gamma knife. n intermittent ipilimumab in addition to nivolumab.
COMPARISON: Multiple prior MR scans with the most recent being 12/12/2019.
TECHNIQUE: Multiple sequences through the brain were acquired at 3T.
CONTRAST MEDIA: Gadolinium as per protocol.
FINDINGS: Extensive prior treatment changes are again demonstrated. Cystic encephalomalacia with irregular peripheral thick enhancement is again demonstrated in the left occipital lobe and is unchanged from 12/12/2019. A further area of cystic encephalomalacia in the left inferior parietal lobule which has a superior focal punctate area of enhancement shows less enhancement than the prior study in 2019. There is unchanged linear and nodular enhancement along the medial aspect of the posterior body of the left lateral ventricle which appears similar to the prior study of 12/12/2019. Enhancement around the temporal horn tips is less prominent bilaterally within the prior study.
There are no new areas of abnormal parenchymal, dural or leptomeningeal enhancement to indicate disease progression.
There is no evidence of hydrocephalus. Normal dural venous sinus enhancement is demonstrated.
There are multiple focal areas of abnormal susceptibility at sites of prior surgery and of prior treated metastases and these is stable from prior. There are no new areas of abnormal reduced diffusion.
IMPRESSION:
Extensive treatment changes with no evidence of disease progression or new metastatic disease.
XR CLAVICLE, BILATERAL 5/7/2020 2:29 PM
CLINICAL HISTORY: Clavicle fracture status post fixation
COMPARISON: Clavicle radiographs 2/11/2020
IMPRESSION:
Redemonstrated plate and screw fixation of the mid to distal right clavicle, in anatomic alignment, without evidence of hardware complication. No evidence of acute fracture. Unchanged calcification adjacent to the left acromion with borderline widening of the left acromioclavicular joint suggestive of prior mild sprain.
Clavicle -- My orthopedic surgeon removed all restrictions he had on using my arm/shoulder.
(At the time of the clavicle break, the report on 12/20 said, "Acute comminuted fracture of the right mid clavicle with butterfly fragment and 2 shaft width displacement and angulation causing skin tenting.")
MR BRAIN WITH AND WITHOUT CONTRAST : 3/17/2020 3:20 PM
CLINICAL HISTORY: Brain neoplasm. Follow-up for brain metastases from melanoma. Additional clinical history from apex: NRAS G12A mutation melanoma of the left neck. Metastatic disease diagnosed in 2010 with lung and brain metastases status post multiple resections and multiple courses of gamma knife. n intermittent ipilimumab in addition to nivolumab.
COMPARISON: Multiple prior MR scans with the most recent being 12/12/2019.
TECHNIQUE: Multiple sequences through the brain were acquired at 3T.
CONTRAST MEDIA: Gadolinium as per protocol.
FINDINGS: Extensive prior treatment changes are again demonstrated. Cystic encephalomalacia with irregular peripheral thick enhancement is again demonstrated in the left occipital lobe and is unchanged from 12/12/2019. A further area of cystic encephalomalacia in the left inferior parietal lobule which has a superior focal punctate area of enhancement shows less enhancement than the prior study in 2019. There is unchanged linear and nodular enhancement along the medial aspect of the posterior body of the left lateral ventricle which appears similar to the prior study of 12/12/2019. Enhancement around the temporal horn tips is less prominent bilaterally within the prior study.
There are no new areas of abnormal parenchymal, dural or leptomeningeal enhancement to indicate disease progression.
There is no evidence of hydrocephalus. Normal dural venous sinus enhancement is demonstrated.
There are multiple focal areas of abnormal susceptibility at sites of prior surgery and of prior treated metastases and these is stable from prior. There are no new areas of abnormal reduced diffusion.
IMPRESSION:
Extensive treatment changes with no evidence of disease progression or new metastatic disease.
XR CLAVICLE, BILATERAL 5/7/2020 2:29 PM
CLINICAL HISTORY: Clavicle fracture status post fixation
COMPARISON: Clavicle radiographs 2/11/2020
IMPRESSION:
Redemonstrated plate and screw fixation of the mid to distal right clavicle, in anatomic alignment, without evidence of hardware complication. No evidence of acute fracture. Unchanged calcification adjacent to the left acromion with borderline widening of the left acromioclavicular joint suggestive of prior mild sprain.
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