A 68-year old male presented with headache, vomiting, and chronic cough with a history of smoking. Imaging found a mass in his right lung and multiple hemorrhagic metastases in his brain. A CT scan showed a 40x33x30mm mass in his right lung lobe, while an MRI revealed several enhancing lesions in his cerebellum and left frontal lobe, with edema and mass effect on his ventricles. Ultrasound also detected a 46x37mm lesion in his right lung. The findings were consistent with pulmonary metastasis to the brain.

1. C A S E O F T H E W E E K

2. • A 68 year old hypertensive male presented with
complaint of headache and vomiting, chronic
cough.
• Patient had a history of chronic smoking.
• Further workup was done, as follows.

3. X-RAY

4. • CT FINDINGS (CECT THORAX): -
• Well defined lobulated heterogeneously enhancing soft
tissue mass seen in apical segment of Right upper lobe
• Few strands seen extending from the lesion up to
apical pleura.
• No evident involvement of pleura or chest wall.
• No evident extension upto hilum.
• Size of the lesion measures 40 x 33 x 30 mm.
• Primary neoplastic mass likely.

6. • MRI FINDINGS (MRI BRAIN):-
• Multiple cerebellar and left fronto-pareital hemorrhagic
metastasis is noted.
• Mass effect (effacement of ventricle) on 4th ventricle
with mild proximal hydrocephalus is noted.
• Marked edema was noted surrounding the lesion.

7. • Multiple (at least 4 in number) heterogeneous enhancing soft tissue mass seen
in both cerebellum and left fronto-parietal lobe.
• Marked surrounding T2/FLAIR hyperintense edema is noted.
• Mass effect with effacement of 4th ventricle.
• Mild dilatation of both lateral and 3rd ventricle seen.
• Right temporal horn measures 7 mm.
• Mild periventricular T2/FLAIR hyperintense CSF oozing is seen.
• Size of the largest lesion measures 36 x 26 x 35 mm in left fronto-parietal lobe
and approx 26 x 30 in right cerebellum.
• Lesions appear hyperintense on T1, T2 and FLAIR, and show patchy restricted
diffusion and blooming on GRE and shows moderate heterogeneous contrast
enhancement and necrotic areas within.

11. • USG FINDINGS:-
• Approx. 46 x 37 mm sized space occupying lesion was
noted in right apical lobe of lung

13. ABOVE MENTIONED CASE WAS OF
PULMONARY METASTASIS TO THE BRAIN.
FURTHER WORK UP AND CLINICO-
PATHOLOGICAL CORRELATION WAS
ADVICED.
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