Clinical question: 72-year-old male with lung, liver masses. Concern for malignancy. Signs and symptoms: Shortness of breath. Pre and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a hemorrhagic ring-enhancing mass in the left anterior frontal lobe with diffuse surrounding vasogenic edema with resultant regional mass effect. Finding is highly suspected of a metastatic lesion measuring 8 x 9 mm in transaxial dimensions.There are 2 abutting ring-enhancing necrotic masses in the left posterior temporal-occipital region without vasogenic edema or mass effect with combined measurement of approximately 16 x 9 mm on sagittal post enhanced series. No convincing evidence of any additional metastatic lesion to brain parenchyma or the leptomeninges and no detectable calvarial or orbital metastatic lesions.A small developmental venous anomaly in the cingulate vagina resolving left parietal lobe is also noted on post enhanced images.Ventricular system and CSF spaces are within normal and the maintained midline.Unremarkable signal intensity of the paranasal sinuses, mastoid air cells and middle ear cavities.
1.Ring-enhancing metastatic lesion in the left frontal and two abutting ring-enhancing metastatic lesion in the left posterior temporal-occipital region as detailed/measured above.2.Small left parietal cingulate gyrus developmental venous anomaly.3.Unremarkable pre and post enhanced study otherwise.