Clinical question: Bladder cancer with new lung primary. Evaluate for CNS metastases. Signs and symptoms: Lung and bladder cancer. CT of brain with contrast:Examination demonstrates multiple bilateral hemispheric and cerebellar metastatic lesions with enhancement and central necrosis and surrounding vasogenic edema. The metastatic lesion within the left cerebellum measures 16.8-mm x 20.7-mm. There is mass effect on the fourth ventricle without complete collapse of the fourth ventricle. There are multiple supratentorial metastatic lesions. The largest of these lesions is along the medial aspect of right temporal lobe and measures 16 mm times 60-mm on axial image 9. There is no evidence of midline shift or hydrocephalus. There is no evidence of leptomeningeal enhancement. Edema surrounding the metastatic lesions produces subtle focal mass effect only. No detectable hemorrhage.The bony density of calvarium is diffusely abnormal with numerous small areas of low density. This is concerning for diffuse miliary metastases lesions to the calvarium. Further study would nuclear medicine scan or an MRI is recommended.108 cc of Omnipaque 350 was utilized for the above study.
1.Multiple intracranial metastatic lesions two bilateral cerebral hemispheres and left cerebellum as detailed.2.There is only focal mass effect secondary to surrounding vasogenic edema of these tumors.3.There is no evidence of hemorrhage or midline shift or hydrocephalus.4.Diffusely abnormal density of the calvarium concerning for miliary metastatic lesions.