Presentation
Persistent dizziness and headache. Recent history of hemoptysis with constitutional symptoms.
Patient Data
An irregularly thick wall peripherally ring enhancing intra-axial mass at the left cerebellum with mild degree of vasogenic edema. Mild effacement of the adjacent forth ventricle, however, no acute obstructive hydrocephalus (no ballooning of the temporal horns of lateral ventricles).
The mass appears to extend into the left cerebellar tonsil resulting in mild tonsillar herniation.
No abnormal leptomeningeal enhancement.
Well-defined hypodensities at right lentiform nucleus and right internal capsule in keeping with old infarcts.
Right hilar mass with hilum overlay sign.
Bilateral hila appear to have lobulated margins which may represent bilateral hilar lymphadenopathy.
Selected axial images confirmed spiculated mass at the superior segment of right lower lobe.
Multiple matted necrotic mediastinal and hilar lymphadenopathy.
Annotated images showed ring enhancing lesion at the left cerebellum.
Case Discussion
Ring enhancing brain lesions carries multiple etiologies (mnemonics MAGIC DR). However, in elderly patients with posterior fossa brain lesion, the most likely differential diagnosis to consider is cerebral metastasis. It is easier to review the chest radiograph for any suspicious lung lesion to suspect lung carcinoma whenever we noticed any posterior fossa lesion, because lung carcinoma is one of the commonest malignancy with cerebral metastasis tendency, especially if the patient is chronic smoker.
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