Presentation
Headaches, nausea and vomiting
Patient Data
Right cerebellar intra-axial mass with irregular peripheral enhancement, surrounded by a large hypodense vasogenic edema. A mass effect is noted on the 4th ventricle and brainstem. Dilated 3rd and lateral ventricles with periventricular hypodensity (interstitial edema) in keeping active hydrocephalus.
A ventriculoperitoneal shunt was inserted and an MRI exam was performed a few days later.
The previously described right cerebellar lesion shows a low signal intensity on T1WI, intermediate signal intensity on T2WI and FLAIR, and heterogeneous enhancement following IV contrast with central necrosis. On DWI it appears of high signal with low ADC (restricted diffusion). Peripheral vasogenic edema with mass effect on the 4th ventricle and brainstem are noted. The adjacent right lateral and straight venous sinuses are patent. The multivoxel MR spectroscopy reveals a dominant peak in Lipids / Lactate (LL), elevated choline peak as well as choline/creatine ratio, and decreased creatine and NAA peak at the solid component of a tumor. The MR spectroscopy at vasogenic edema around the lesion (not shown) demonstrated a pattern of depressed metabolites.
A peripheral cavitating mass with irregular and spiculated border is seen in the superior segment of the right lower lobe. Right hilar, subcarinal and paraesophageal lymphadenopathy are seen.
Diffuse centrilobular emphysema is noted
Case Discussion
Radiological appearances are highly suggestive of a solitary cerebellar metastasis from lung tumor
In the presence of a solitary cerebellar lesion in an elderly patient, a metastasis should be considered as the first diagnosis unlike a child or young patient where a primary tumor should be discussed first.
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