Lung primary with cerebral and adrenal metastases

Case contributed by Varun Babu
Diagnosis almost certain

Presentation

Chronic smoker, loss of weight and appetite, cerebellar ataxia.

Patient Data

Age: 55 years
Gender: Male
This study is a stack
Axial
T2
This study is a stack
Axial
FLAIR
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Axial
DWI
This study is a stack
Sagittal
T1
This study is a stack
Coronal
T1 C+
This study is a stack
Axial
T1 C+
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Info

Multiple enhancing neuroparenchymal lesions of varying sizes are seen more in the cerebellum, largest in suprasellar region and smaller ones in the supratentorial neuroparenchyma. The number and distribution of lesions prompted an immediate workup for primary elsewhere in the body.

A CT chest, abdomen and pelvis was ordered to look for a potential primary. 

This study is a stack
Axial lung
window
This study is a stack
Axial
non-contrast
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Info

Infiltrative parenchymal lung neoplasm with right upper lobe bronchial cut off and mediastinal lymphadenopathy favoring a lung primary. 

Abdomen and pelvis

ct
This study is a stack
Axial C+ portal
venous phase
This study is a stack
Coronal C+ portal
venous phase
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Info

Bilateral enhancing enlarged nodular suprarenals favoring secondaries.

The rest of the abdominal study was unremarkable. 

Case Discussion

A good demonstration of Stage IV lung metastatic disease, the hematogenous spread to both adrenals as well as the brain demonstrated in this late presentation. There was no familial history, but a history of 40 pack years had a contributory effect. 

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