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CASE 4: Discussion
How would you work up this patient if he did not have a known cancer diagnosis?
- Since the patient has a significant smoking history, you should suspect that this patient likely has a primary lung cancer. A chest CT would be ordered to look for a primary lung cancer.
- In women it is important to consider breast cancer as a potential source for a primary neoplasm. A breast examination and a mammogram should be performed.
- In both men and women a chest/abdomen/pelvis would be ordered to look for other types of cancers such as renal cell cancer or colon cancer.
- This patient had a chest CT which showed a primary lung cancer within the right lower lobe.
This CT image of the lung shows a large mass within the right lower lobe consistent with a primary lung cancer.
Imaging Appearance of Brain Tumors
Brain tumors can have varied appearance on imaging. They can be single or multiple, appear solid or cystic, can be associated with or without hemorrhage and can occur anywhere. For a great tutorial on brain tumors see link below from radiology assistant.
Location: We use location to help narrow our differential for specific tumor types. The first question that we ask is " Is the tumor arising from the brain parenchyma (intra-axial) or outside the brain parenchyma (extra-axial)?"
Intra-axial
Extra-Axial
- Primary brain tumor (astrocytoma, oligodendroglioma etc. )
- Metastatic Disease (solitary or multiple)
- Not a tumor (inflammatory, hematoma tec.)
- Meningioma
- Meningioma
- Meningioma
- Meningioma
- Metastastic Disease
- Not a tumor (inflammatory, etc)
MR example of a patient with a known diagnosis of lung cancer with numerous intra-axial enhancing masses throughout the brain parenchyma. This patient was found to have metastatic lung cancer.
MR example of a patient with an incidentally found extra-axial mass noted adjacent to the left cerebellum. Notice how there is a cleft between the enhancing mass and the adjacent brain parenchyma. Given that these lesion is arising from the dura and is external to the brain parenchyma, the imaging features are most suggestive of a meningioma based on on location. Meningiomas are benign tumors, but are often resected because of potential mass effect and other complications.
Additional Resources
Radiology Assistant: Brain Tumor- Systematic Approach
ACR Appropriateness Criteria in patients with brain metastasis
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