Diagnosis: Malignant neoplasm of unspecified part of right bronchus or lungClinical question: concern for metastatic disease versus infectionSigns and Symptoms: hx of SCLC s/p chemotherapy, radiation, PCI; episodes of aphasia, fever, hypotension The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions are present in the brainstem.No abnormal mass lesions are appreciated intracranially. 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 are partially opacified. The visualized portions of the orbits are intact. The eye lenses are thin.
1.Periventricular and subcortical white matter lesions of a mild degree as well as lesions in the brainstem are nonspecific. At this age they are most likely vascular related. This is stable compared to the prior exam.2.No postcontrast imaging was performed. Please note that post contrast MRI is more sensitive for the detection of brain metastases. There is no evidence for bran metastases on the available imaging.