91 years, Female, intracranial mass on head CT. Evaluate for abscess versus neoplasm.. There is a 2.2 x 2.2 x 2.0 cm (AP x transverse x craniocaudal) mass with nodular peripheral enhancement and central necrosis involving the lateral aspect of the right middle frontal gyrus. There is extensive surrounding FLAIR hyperintensity consistent with vasogenic edema. There is mild restricted diffusion involving the peripheral aspect of the lesion. No central restricted diffusion to indicate pus. There are punctate foci of susceptibility along the peripheral aspect of the lesion compatible with microhemorrhages. There is local mass effect with mild sulcal effacement as well as mild effacement of the right lateral ventricle. There is minimal leftward midline shift measuring 3 mm at the foramen of Monro.There is a 5 mm lesion with peripheral enhancement and minimal associated edema involving the left anterior middle frontal gyrus. There is also a 5 mm lesion involving the left paramedian parietal lobe.There is a punctate focus of susceptibility likely indicating chronic microhemorrhage in the right anterior frontal lobe and nonspecific. Patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter is nonspecific but compatible with chronic small vessel ischemic disease.No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. Sella and orbits are grossly unremarkable. There is minimal scattered paranasal sinus mucosal thickening. Calvarium and extracranial soft tissues are also grossly unremarkable.
2.2x2.2x2.0 cm mass in the right frontal lobe with peripheral nodular enhancement as well as 5 mm left frontal and left parietal lesions are highly suspicious for metastatic disease. Imaging features are not compatible with pyogenic abscesses although atypical infection may be considered in the appropriate clinical setting.