Female, 70 years old, with aphasia and right upper extremity weakness, left parietal lesion seen on head CT. History of lung cancer. Numerous, at least 7, enhancing lesions are demonstrated within the brain and cerebellum. These are found within the left frontal lobe, left parietal lobe, along the left sylvian fissure, in the right insula and temporal lobe, and in the right cerebellar hemisphere. The largest lesion, along the Sylvian fissure, measures up to 25 x 24 mm. The lesions show heterogeneous but predominantly peripheral enhancement.As the majority of lesions are present within the left cerebral hemisphere, there is extensive, nearly confluent edema tracking through all the left-sided cerebral lobes including the insula and basal ganglia. A midline shift to the right of up to 9 mm is seen, and the left uncus is medialized. No evidence of transtentorial herniation is seen. Lesions outside of the left cerebral hemisphere also elicit modest local edema.The left lateral ventricle is effaced. The right lateral ventricle is of relatively normal caliber. The third ventricle is effaced and the fourth ventricle is normal. No evidence of intracranial hemorrhage is seen.
Numerous, at least 7, enhancing lesions are demonstrated in the brain and cerebellum compatible with metastases. The majority of these are located within the left cerebral hemisphere where they cause extensive, nearly confluent edema and substantial generalized mass effect.