Diagnosis: Malignant neoplasm of bronchus and lung, unspecified site Other malignant neoplasm without specification of siteClinical question: looking for brain mets given metastatic lung cancer, possible candidate for WBRTSigns and Symptoms: metastatic lung cancer There are punctate foci of diffusion weighted imaging signal hyperintensity present one in the subcortical white matter of the right precentral gyrus another one in the right centrum semiovale and another one in the subcortical white matter of the right inferior parietal lobule another is present in the left frontal lobe subcortical white matter and middle frontal gyrus and another one is present in the left posterior temporal lobe subcortical white matter in the couple more are present in the cerebellar hemispheres. Some of these are associated with some subtle perceptible diffusion restriction by ADC map but this is not evident on all of the lesions. These lesions can also be identified on FLAIR and T2 MRI and are not associated with any susceptibility effect. There is no associated contrast enhancement appreciated with these lesions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella
There are multiple lesions scattered in the subcortical and periventricular white matter as well as the cerebellar hemispheres numbering approximately 15. These are nonspecific and of unclear etiology. It's possible that these represent vascular events in the late subacute stage. Given the patient's history of the lung cancer a follow-up exam would help exclude the possibility is these are related to metastatic disease. Another possibility is that these are related to septic emboli. 