What is in your differential for a ring enhancing lesion?
Always remember the MAGIC DR! Metastases Abscess Glioblastoma Infarct (subacute) Contusion Demyelination (broken ring) Radiation/Resolving haematoma
What tests would you do next?
CT chest/abdomen/pelvis with examination +/- imaging of the breasts (in female patients) and testes (in males), to find any evidence of malignancy elsewhere. Also MRI head with contrast for further evaluation of the lesion, and for any other smaller foci not detected on CT.
5 x 5 x 4 cm ring enhancing lesion in the right frontal lobe, with extension across the corpus callosum.
Moderate perilesional reduced attenuation and mass effect with effacement of the anterior right lateral ventricle. Patent basal cisterns.
Body CT performed at the same time did not demonstrate malignancy elsewhere.