Haemorhagic brain metastases

Case contributed by Dr Andrew Lawson



Patient Data

Age: 70
Gender: Male

Multiple haemorhagic lesions. See MR report.


Multiple intra-axial hemorrhagic mass lesions demonstrated; largest within the right temporal lobe which has a fluid level measuring 60mm x 40mm causing effacement of the adjacent sulci, right uncal herniation and left sided midline shift with effacement of the right lateral ventricle. Other smaller intra-axial hemorrhagic mass lesions demonstrated within the left superior frontal gyrus (measuring 19 mm x 18 mm), the right posterior frontal lobe (measuring 48 mm x 32 mm) and the left mesial occipital lobe (measuring 10 mm x 11 mm). All the lesions demonstrate surrounding FLAIR high signal with effacement of the adjacent sulci.

Conclusion: Imaging appearance in keeping with multiple hemorrhagic metastases, largest within the right temporal lobe causing left sided midline shift and right uncal herniation.


Chest Extensive hilar and mediastinal adenopathy; Right paratracheal node measuring 16 mm, Subcarinal node measuring 18 mm, 2 large left hilar nodes measuring 16 and 24 mm respectively. Multiple pulmonary nodules ranging in size from 5 mm to 25 mm scattered throughout both lungs. No pleural effusions. No regions of focal consolidation. Marked degenerative change throughout the thoracic spine with partial insufficiency collapse of the T6 and 7 vertebral bodies with preservation of more than 70% of the vertebral body height. Healed posterior rib fractures on the right of ribs 9, 10 and 11.

Abdomen There is a large heterogeneously enhancing mass arising from the mid and lower pole of the right kidney extending beyond the cortical margin measuring approximately 87 x 60 mm. The right renal vein opacifies normally. No opacification is demonstrated in the juxtarenal IVC, consider technical. There is a second renal lesion within the upper pole of the left kidney expanding the cortex and resulting in loss of the cortico-medullary junction. The lesion measures approximately 39 mm in diameter. There is a 36 x 54 mm mass within the right adrenal. The left adrenal is normal. The liver, pancreas and spleen enhance homogeneously. No para-aortic adenopathy. No free intra-abdominal fluid. The small and large bowel are unremarkable.

Conclusion: 1. metastatic disease to the lungs and right adrenal. 2. large mass within the right kidney likely represents the primary lesion. 3. the smaller mass in the left kidney represents either a synchronous urothelial primary neoplasm or less likely a metastatic deposit. 4. no bony lesions.

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Case information

rID: 25633
Published: 1st Nov 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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