Female, 77 years old, with lung cancer, stage III, not yet on therapy. Initial staging head CT showed an abnormal finding. The lesion identified on prior CT within the right frontal white matter is demonstrated as an area of mild susceptibility artifact and mild ill-defined FLAIR hyperintensity. This lesion shows no detectable enhancement on the early postcontrast images, and on the later postcontrast images shows only a faint rim of enhancement (image 106 series 1201). The high attenuation of this lesion seen on CT may therefore have represented mineralization. The lesion causes no significant edema or mass effect.No evidence of any other definite pathologic intracranial enhancement is seen. A small ill-defined blush of enhancement within the right precuneus is favored to represent a developmental venous anomaly. No parenchymal edema or mass effect is noted. There are several scattered small foci of T2 hyperintensity within the periventricular white matter which are nonspecific but likely reflective of chronic microvascular ischemic disease. No restricted diffusion is seen.There is no evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection. In addition to the susceptibility noted above, a 2 mm focus of susceptibility is also noted adjacent to the right frontal horn suggesting chronic microhemorrhage. The ventricles and sulci are mildly prominent compatible with parenchymal volume loss, but are otherwise unremarkable.No definite marrow signal abnormality is seen. Thinning of the bilateral parietal bones is an age-related anatomic variant. The odontoid process appears somewhat angulated and/or retroflexed. This may be congenital or reflective of remote trauma. The posterior arch of C1 is not clearly visualized in its entirety.
The lesion identified on prior CT within the right frontal lobe is identified on today's examination as an area of either mineralization or hemosiderin staining with minimal rim enhancement and no significant associated edema or mass effect.The etiology for this lesion is not entirely clear. While metastatic disease cannot be entirely excluded, the presentation is rather atypical. Benign etiologies would also be in the differential including sequelae of prior injury or inflammation. Given the uncertainty, a short-term follow-up examination, perhaps in one to two months, can be considered.