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CT-scan shows a voluminous parieto-occipito-temporal hypodense lesion with intense focus of nodular enhancement in its lateral portion, associated with vasogenic edema. The density is slightly higher than CSF. There is an associated diffuse ipsilateral leptomeningeal enhancement & slight right temporal uncal herniation. The right lateral ventricle is sequestred.
The differential diagnosis for cystic intra-axial lesions with nodular enhancement portions includes :
- isolated cystic metastases
- pilocytic astrocytoma : usually posterior fossa & more common in children
- DNET : usually little if any enhancement
The patient had a known ovarian cancer. The most probable diagnosis remains metastases in this patient with possible leptomeningeal carcinomatosis. MRI was recommended.