Intracranial metastasis with mass-effect and renal osteodystrophy
Presentation
Uncharacterized primary lung malignancy (refused further workup). On long term hemodialysis. Right-sided hemiparesis that gradually developed. Associated slurred speech and aphasia. Somnolent. ?IC metastasis
Patient Data
STAT CT brain without contrast (end-stage CKD, imaging appearance pathognomonic on wet read, thus no IV contrast was adminitered):
36 x 26 x 22 mm inhomogeneous mass in the left temporo-parietal region, in line with partially necrotic metastatic tumor
significant associated perifocal vasogenic edema (note cortical sparing), midline shift, compressed left lateral ventricle
subtle 15 mm hypodensity noted along the left caudate nucleus
diffuse osteosclerosis, in line with chronic renal osteodystrophy (known)
Five years earlier prior study shows the earlier status, osteodystrophy was already present, also note the pathognomonic salt and pepper appearance.
Case Discussion
Typical imaging appearance of a solitary intracranial metastasis from a lung primary, with significant associated mass effect. If scrutinized carefully, even noncontrast CT brain can provide considerable amount of information. Renal osteodystrophy is incidental and associated with long-term HD.
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