Presentation
Middle aged female presents with a right sided ocular and facial palsies.
Patient Data
2 cm rim enhancing lesions in the right frontal lobe with a small amount of perilesional edema. No significant mass effect.
Multiple additional high attenuation lesions measuring up to 1 cm in both cerebral hemispheres. All the lesions cortical based.
1.7 cm rim enhancing lesion in the region of the right internal meatus abutting the lateral brainstem.
Orbits normal. Normal nasopharynx.
Multiple enhancing lesions throughout both cerebral hemispheres, most of which are ring-enhancing, measuring up to 2.3 centimeters.
The right frontal lobe lesion has perilesional edema, but no significant mass effect.
Right brainstem lesion.
No internal diffusion restriction of any of these lesions.
Comment: Appearances in keeping with widespread cerebral metastases
CT chest
3.5 spiculated centimeter mass in the left upper lobe abutting the aortic arch and invading the mediastinal fat. Tiny focus of calcification within.
1.1 centimeter enhancing left lower lobe pleural nodule.
Several right axillary lymph nodes measuring up to 1.7 centimeters. 1cm AP window lymph node.
CT abdomen
The solid organs are unremarkable.
Fibroid uterus.
No intfradiaphragmatic lymphadenopathy. No focal bone lesion.
Surgical biopsy from chest
The report from the surgical biopsy.
CT guided biopsy was not feasible.
Case Discussion
Comment: Appearances would be most consistent with a left upper lobe lung cancer.
Radiological stage TIV, N1, M1
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