Presentation
Headache for a couple of months, no fever, no cough.
Patient Data
Axial FLAIR shows diffuse elevated signal within sulci. No abnormality in T1W, MRA, Gradient Echo, and DWI/ADC.
T1 C+ and the late post-contrast FLAIR sequence show diffuse leptomeningeal enhancement. No enhancing nodules were seen in the leptomeninges and the brain parenchyma.
The diffuse enhancing leptomeningeal enhancement in young men leads to the diagnosis of meningitis or meningeal carcinomatosis. However, the latter seems less likely due to the patient's age.
The lumbar puncture was obtained. The results showed a slightly elevated protein level (1.1 g/L), normal glucose level, no RBCs, and a minimal number of white blood cells in the cerebrospinal fluid. Mycobacterium tuberculosis PCR in the CSF and CSF cultures are both negative.
Irregular-margined nodule in the left upper lobe.
Right lobe: A sub-solid nodule (measured about 10 mm) in the upper lobe
Left lobe: A solid nodule measured about 20 mm, lobulated and spiculated borders in the upper lobe (Lung-RADS 4X). Some other small nodules (estimated about 5 mm) scattered over the remaining lung field.
A mediastinum lymph nodule (20x10 mm) was seen as well.
The left lung nodule was then biopsied with the pathology results revealing adenocarcinoma.
Mycobacterium tuberculosis PCR and MGIT of the sample from the left upper lobe were both negative. AFB smear of the patient's sputum and blood Mycobacterium tuberculosis quantiferon were both negative.
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