Solitary supratentorial metastasis

Case contributed by Dr Subash Thapa

Presentation

50 years male with altered level of consciousness and seizure, also gives history of hemoptysis and significant weight loss.

Patient Data

Age: 50 years
Gender: Male

Chest X-ray

Modality: X-ray

There is a large well defined homogeneous opacity involving the right upper zone.

MRI Brain

Modality: MRI

There is an irregular heterogeneous ring enhancing supratentorial lesion (T1+C) measuring 2.3x1.8x cm in the right high parietal region with central non-enhancing necrotic core. There is significant perilesional edema (vasogenic edema - hyper on T2/FLAIR, no restriction on DWI) causing mass effect as evidence by the effacement of the ipsilateral atrium, lateral ventricle and the adjacent cortical sulci.

DWI image shows hyperintense (restricted) solid area with is hypointense of ADC.

Modality: MRI

There is prominent lipid/lactate signal (1.3 ppm), elevated choline peak (3.5 ppm), decreased creatine (3.03 ppm) and decreased NAA peak (2.02 ppm) with choline:creatine ratio of 2.16 at the enhancing solid area.

Peak of all the metabolites is normal in the perilesional edema with maintained Hunter angle.

Case Discussion

The patient had lung mass in the right upper pulmonary lobe. 

Solitary lesion is among half of the adult with cerebral metastases where cerebral hemisphere is the commonest site.

Solitary metastases do not spread directly into (and beyond) peritumoral oedema unlike GBM which is demonstrated by choline peak in the peritumoral edema in MRS.

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Case Information

rID: 41384
Case created: 29th Nov 2015
Last edited: 18th Oct 2016
Inclusion in quiz mode: Included

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