Presentation
Two weeks of headache and vomiting in a known case of nasopharyngeal carcinoma status post radiotherapy.
Patient Data
Multiple rounded intra-axial cystic lesions at grey-white matter interface with surrounding extensive vasogenic edema in left frontal, parietal, and right temporal lobes. Mass effect effaces the cortical sulci, lateral ventricle (left greater than right), and the basal subarachnoid cisterns (suprasellar, prepontine and quadrigeminal).
Post-contrast demonstrates post-contrast peripheral enhancement. Some lesions contain a thin and smooth enhancement pattern while the left parietal lesions reveals irregular and thickened rim enhancement.
Nasopharyngeal soft tissue enhancement and bilateral effacement of the fossa of Rosenmuller. Soft tissue extends anteriorly to involve the nasal cavity, primarily on the left.
Case Discussion
Findings on this CT may be seen in the setting of multiple brain cystic metastases, especially in a patient with known nasopharyngeal cancer. Given its rarity, other ring-enhancing lesions should be considered (e.g. MAGIC DR).
Further workup with MRI demonstrated restricted diffusion consistent with abscesses. No evidence for metastatic lesions or radiation necrosis was identified.
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