Leptomeningeal metastases from lung carcinoma

Case contributed by Dr Bruno Di Muzio

Presentation

History of lung carcinoma.

Patient Data

Age: 58
Gender: Female

MRI Brain

Modality: MRI

 

There are multiple nodular enhancing lesions identified involving the sulci and adjacent the cortex of the middle left frontal gyrus, inferior left frontal gyrus, left parietal lobe, right occipital lobe and in the right superior frontal gyrus. Those in the left frontal lobe exhibit ring enhancement pattern and surrounding oedema, however without significant mass effect over the brain parenchyma. Spectroscopy performed in the left inferior frontal lesion demonstrates mild choline elevation. MRI perfusion is unremarkable.

Remainder a ppearance and intensity of brain parenchyma is normal.

Ventricular system and cisternal spaces appear normal.

There is no shift of the midline structures.

The visualized orbits, paranasal sinuses and calvarium appear unremarkable.

Conclusion:

Multiple brain enhancing lesions in keeping with metastatic disease.

Case Discussion

In a patient with a known history of lung carcinoma these multiple nodular ring enhancing lesions are in keeping with CNS metastasis. Instead of being located in the white-grey matter junction, these lesions are identified involving the sulci and adjacent cortex, which suggests more a leptomeningeal involvement than a brain parenchyma involvement. 

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Case Information

rID: 39130
Case created: 21st Aug 2015
Last edited: 30th Aug 2015
Tag: rmh
Inclusion in quiz mode: Included

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