Cerebral ring enhancing lesions - cerebral metastases

Case contributed by Dr Ian Bickle


Middle aged female presents with a right sided ocular and facial palsies.

Patient Data

Age: 58
Gender: Female

2 cm rim enhancing lesions in the right frontal lobe with a small amount of perilesional oedema. 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 centimetres.

The right frontal lobe lesion has perilesional oedema, 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 centimetre mass in the left upper lobe abutting the aortic arch and invading the mediastinal fat. Tiny focus of calcification within.

1.1 centimetre enhancing left lower lobe pleural nodule.

Several right axillary lymph nodes measuring up to 1.7 centimetres. 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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Case information

rID: 44922
Published: 21st May 2016
Last edited: 17th Oct 2017
Inclusion in quiz mode: Included

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