Hyperdense cerebral metastasis

   May 15, 2020  Posted in Central Nervous System, Tumour

Clinical:

  • A 72 years old man
  • Underlying HPT and hyperlipidaemia
  • Presented with forgetfulness x 3/52.
  • Associated with weakness at right UL and LL.
  • Clinical examination shows receptive dysphasia. Power right UL and LL 4/5.
  • Urgent plain CT scan brain requested to rule out CVA.
Non-contrast CT brain in axial planes

CT scan findings:

  • Multiple round hyperdense lesions are seen at the grey-white matter junction in both cerebral hemispheres. The largest is seen at the right frontal region, measuring about 2.9(AP x 2.9(W) x 3.0(CC)cm.
  • Some of these lesions demonstrate central hypodensity, likely suggestive of central necrosis.
  • Marked perilesional white matter oedema with effacement of the adjacent sulci is seen. The body of the left lateral ventricle is slightly compressed.
  • No midline shift. No hydrocephalus. Basal cisterns are not effaced.
Chest radiograph PA erect view

Radiographic findings:

  • There are multiple well defined nodules seen in right and left lower zone
  • The largest in right lower zone measured 2.2 x 2.0 cm.
  •  No consolidation. No pleural effusion or pneumothorax. No hilar enlargement seen. Heart size is within normal range.
CT scan of abdomen in axial plane; pre contrast (upper row) and post contrast (lower row)

CT scan findings:

  • There is a large heterogeneously enhancing lobulated mass seen occupying the upper and interpolar regions of the left kidney, measuring at 8.5 x 5.6 x 6.6cm (AP x W x CC). The mass vividly enhances post contrast with central hypodensities noted, possibly representing central necrotic cores. No calcification seen within the mass.
  • The mass extends into the renal pelvis region. No hydronephrosis seen.
  • The left renal vein is well opacified with no apparent filling defect seen within to suggest presence of thrombosis. The renal arteries appear unremarkable.
CT scan of thorax in axial plane, lung windows showing multiple lung nodules

Diagnosis: Hyperdense cerebral metastasis from left renal carcinoma

Discussion:

  • Cerebral metastases are estimated to account for approximately 25-50% of intracranial tumors in hospitalized patients.
  • The term cerebraltechnically includes the cerebrum, the cerebellum and the brainstem.
  • Hyperattenuating brain metastasis (on CT scan) can be caused by malignant melanoma, choriocarcinoma, colon cancer, renal cell cancer and thyroid cancer.

Progress of patient:

  • Condition of patient deteriorated.
  • Patient died one  month after the presentation.

 

Author: radhianahassan