Metastatic bronchogenic carcinoma

This 42 year old woman with a long history of tobacco use began having headaches one month before these images were obtained. The headaches intensified during the previous week, and she noted trouble finding her words. The diagnostic workup included a chest CT scan that showed a right upper lobe lung lesion consistent with bronchogenic carcinoma, a diagnosis later confirmed by lung biopsy.

Brain images show a large mass with surrounding edema, and compression of adjacent midbrain structures. The MR demonstrates the tumor as an area of high signal intensity on proton density (PD) and T2-weighted (T2) images in a large left temporal region. Contrast enhancement shows the lesion to contain a cystic component here. The greatly swollen left hemisphere is reflected in the narrowed sulci seen at higher levels; compare the right and left sides here. X-ray CT images were obtained with contrast, before and after decompressive surgery. The effects of surgery are seen in the postoperative images. The point of skull opening is seen here, and low attenuation air pockets normally introduced during surgery here. Perfusion SPECT shows very low blood flow to the lesion.

Some details have been altered to protect confidentiality.

Keith A. Johnson (keith@bwh.harvard.edu), J. Alex Becker (jabecker@mit.edu)