Clinical question: 24-year-old male with metastatic Ewing sarcoma, persistent headaches, evaluate for progression of Ewing's, brain abscess or other pathology. Signs and symptoms: Headaches Nonenhanced CT of brain:Examination demonstrate a large extra-axial mass of high density in the right posterior parietal region with associated lytic changes of inner table of the skull (axial images 35 through 38) the mass causes significant mass effect and buckling of the cortex. At this level there is also a large extracranial high-density mass which measures approximately 62 mm times 30 mm in size. This finding is also associated with some irregularity of the outer table of the skull. Considering the provided clinical history of Ewing sarcoma this finding is highly suspected of a metastatic lesion to the calvarium with intracranial and extracranial spread of tumor.There is evidence of associated edema of brain parenchyma adjacent to this finding (axial images 29 through 34). The extra-axial mass has higher density than brain parenchyma and on a few of the images appears like a subdural hematoma. Further evaluation with an enhanced MRI of brain is highly recommended.There is no evidence of parenchymal hemorrhage, hydrocephalus or midline shift.Visualized paranasal sinuses and mastoid air cells are unremarkable.
Lytic changes of the inner and outer cortex of right parietal bone with associated large high density mass in the extra-axial intracranial space and within the soft tissues of the scalp. Finding is highly suspected of osseous metastatic lesion with both intracranial and extracranial spread. The combination of these masses measures approximately 40 mm in thickness and 85-mm in longus cranial slice cephalad axis (coronal reformatted image 47). There is evidence of mass effect on the brain parenchyma and vasogenic edema. No midline shift or hydrocephalus.Above findings were discussed with Dr. Gornli Jerome pager number 2841 at the time of interpretation.