Diagnosis: Malignant neoplasm of upper lobe, right bronchus or lungClinical question: vertigo; also history of lung cancer with non-specific vascular abnormality in brainstem on staging brain MRI from an outside institution; please evaluate for etiology of vertigoSigns and Symptoms: vertigo The CSF spaces are appropriate for the patient's stated age with no midline shift. A small ill-defined focus of enhancement is present along the right paramedian pons which is associated with loss of signal on the susceptibility weighted imaging. It is associated with minimal T2 and FLAIR signal hyperintensity and no evidence for diffusion restriction.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate some minor opacities. The visualized portions of the orbits are intact.Incidental note is made of a a Thornwaldt cyst in the posterior nasopharyngeal mucosal space of the nasopharynx.
1.A small lesion in the pons is suspected to represent capillary telangiectasia rather than metastatic disease. If clinically appropriate, given the patient's clinical history for possible metastases, follow-up exams would help confirm this.