Presentation
This patient presented with a cerebral abscess.
Patient Data
There is a large cavitating lesion within the left lower lobe, with smaller pulmonary lesions extending to the hilum. Left hilar lymphadenopathy is noted. The right lung is clear. The cardiac silhouette is not enlarged. The differentials would include infection and a neoplastic process.
There is a large peripherally based mass in the left lower lobe, measuring 7.8 x 4.4 x 8.4 cm. This shows central cavitation, and mild surrounding groundglass opacity. Multiple smaller pulmonary nodules are seen extending medially toward the hilum with a peribronchovascular distribution, and there is extensive left hilar and mediastinal lymphadenopathy which shows some central low attenuation. A subcarinal lymph node measures 3.8 x 2.7 cm and an aortopulmonary lymph node measures 3.6 x 1.9 cm.
Left upper lobe and the right lung is clear, with no airspace opacity or pulmonary lesions. Bilateral apical subpleural bullae, left greater than right. No pneumothorax or pleural effusion. No rib changes. No suspicious expansile or destructive osseous lesions. The visualized upper abdominal viscera are unremarkable.
Case Discussion
The brain lesion was biopsied: "Brain tissue: Metastatic undifferentiated non-small cell carcinoma with features most consistent with an origin from lung."
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