Clinical question: 66-year-old male with NSCLC and two brain metastases. Treatment planning MRI for SRS. Patient has remote history of head trauma in 1989 and was hit with a pipe along right skull Signs and symptoms: None. Pre-and post enhanced treatment planning brain MRI:There is a tiny ring enhancing lesion in the superior aspect of the left cerebellar measuring at 5 x 5-mm stable since prior exam and suspected for a small metastatic lesion. There is no detectable blood product with this finding.Additionally a tiny superficially located focus of ring enhancement in the anterior right frontal lobe measuring also approximately a 5-mm in transaxial dimensions. There is hemosiderin deposition at this location within the brain parenchyma likely has result of prior trauma. This finding although highly suspected of an additional metastatic lesion, the less likely possibility of enhancement surrounding chronic hemorrhage at the site cannot be entirely excluded.Examination redemonstrates multiple foci of hemorrhagic encephalomalacia from patient's known prior injury to the head.
1.Approximately 5 mm ring enhancing metastatic lesion along the superior surface of left cerebellar.2.Approximately 5 mm enhancing metastatic lesion superficially in the right anterior frontal lobe.3.Chronic posttraumatic hemorrhagic changes of brain as was noted on prior dedicated brain MRI.