Presentation
Known metastatic breast cancer. Now slurred speech and arm weakness.
Patient Data
Diffuse left convexity dural thickening and enhancement with a defect in the overlying skull vault extending into the subcutaneous fat. In the context of known bone mets from breast cancer this appearance indicates a bone lesion that has grown through into the dura (pachymeninges).
Multiple focal hot spots in the skull including the left parietal region indicative of metastases.
Subtle infiltrative lytic lesion in the left parietal bone at the site of MRI abnormality consistent with metastasis.
Case Discussion
Dural metastasis can either be primarily involved with tumor via hematogenous spread or extend from the adjacent calvarial bone. Most common primary sites are breast, lung, prostate, renal, melanoma. The involvement can be diffuse as in this case or more focal. It tends to be nodular.
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