Presentation
Presenting to emergency department with nausea and vomiting and a seizure.
Patient Data
Axial sequential acquisition through the brain without intravenous contrast.
There is a hyperdense lesion (26 x 22 mm) with central hypodensity in the posterior left frontal lobe that demonstrates contrast enhancement with a small amount of surrounding hypodensity. There is enhancement of the adjacent thickened dura and the bone is thinned, mottled and irregular.
Post contrast administration. there is a further enhancing lesion in the anterior right middle cranial fossa that extends through the optic canal to run along the right lateral orbital wall. There is no clear fat plane between the lateral rectus and the lesion. The underlying bone is thickened and sclerotic.
Multiple other vague areas of bony sclerosis are noted in keeping with widespread metastatic disease.
No intra or extra-axial hemorrhage is seen. Ventricles and sulci are within normal limits for age.
Case Discussion
This patient has known metastatic lung cancer, and demonstrates how lung metastases can cause bony sclerosis and hyperdense cerebral metastases.
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