Clinical question: 71-year-old female with stage IV non-small cell lung cancer and known brain metastases. Restaging CT. Signs and symptoms: Same Enhanced head CT:No contrast was given for this study. This examination was performed after an enhanced CT of chest abdomen and pelvis.Examination again demonstrates an enhancing high convexity left anterior parietal metastatic lesion measuring 12.8 x 13.2-mm in size. This is associated with extensive surrounding vasogenic edema and effacement of adjacent cortical sulci. Very subtle mass effect on the left lateral ventricle is also present. There is approximately 3 mm midline shift to the right. Precise comparison to prior exam is not possible due to severely degraded images on prior MRI exam secondary to motion. Within this limitation however there is suggestion of possible minimal reduction in the size of tumor. Compared to prior nonenhanced head CT the degree of vasogenic edema on overall mass effect remains similar.There is no evidence of any additional foci of parenchymal or leptomeningeal enhancement to suggest additional metastatic lesions. Calvarium is also intact.There is a focus of vascular enhancement at the level of the supraclinoid right internal carotid artery suggestive of atherosclerotic aneurysmal dilatation or an aneurysm of the supraclinoid right internal carotid. This finding was noted on prior MRI exam. This finding measures approximately 9.6 x 6.6-mm in size. Recommend further follow-up with a CTA or MRA of intracranial circulation.Multiple attempts to contact with the referring clinical physician failed. Findings were relayed to Dr. Rhee Charles (pager 2869) via paging system at time of review of the exam.
1.Revisualization of a left parietal metastatic focus with extensive surrounding edema. The overall surrounding vasogenic edema and mass effect remain similar to prior study. There may be slight interval decrease in the measurement of tumor.2.Either atherosclerotic aneurysmal dilatation or a berry aneurysm of the proximal right supraclinoid internal carotid artery. 