Diagnosis: Disorder of brain, unspecifiedClinical question: eval brain mass noted on CT head -- infection vs malignancySigns and Symptoms: newly diagnosed brain mass and lung mass There is a ring-enhancing lesion measuring 11 mm in diameter present along the right centrum semiovale associated with adjacent T2 and FLAIR signal hyperintensity suggestive of vasogenic edema. The lesion is adjacent to the right lateral ventricle and distorts the parenchymal lining of the right lateral ventricle. Centrally within the fluid collection there is diffusion restriction. The margins of the ring enhancing lesion are smooth. On T2 imaging the ring is low signal.There is a ring-enhancing lesion present along the right cerebellar hemisphere measuring 11 mm in diameter with similar characteristics as the right centrum semiovale ring-enhancing lesion. There is associated vasogenic edema.There is a 4 mm focus of ring enhancement along the left occipital pole subcortical white matter which also present diffusion restriction and vasogenic edema.There is diffusion restriction present within the right lateral ventricle associated with the FLAIR signal hyperintensity along the subependymal lining of the right lateral ventricle. There is some patches of abnormal enhancement present along the right lateral ventricle.A small focus of diffusion restriction is present in the fourth ventricle. This associated with intermediate signal on FLAIR imaging but no significant contrast enhancement.There is a punctate focus of diffusion restriction along the posterior aspect of the left occipital horn of the left lateral ventricle.A small amount of diffusion restriction is also present within the inferior aspect of the third ventricle.Some punctate foci of diffusion restriction are present adjacent to the cerebellar hemispheres and vermis.A T2 and FLAIR hyperintense punctate subcortical white matter lesion is present adjacent to the left frontal lobe.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 demonstrate minor mucosal thickening. The visualized portions of the mastoid air cells demonstrate minor opacities.. The visualized portions of the orbits are intact.
1.Findings are compatible with multiple abscesses (most likely pyogenic) located adjacent to the right lateral ventricle subependymal region and centrum semiovale, right cerebellar hemisphere and left occipital lobe. There is associated ventricular involvement predominantly involving the right lateral ventricle but with extension into all ventricles. There is right lateral ependymitis. Additionally, there is some indication of posterior fossa cisternal involvement.2.Findings were discussed with Michael Cui of the referring clinical service including the ventricular involvement.