77 year-old with recent syncopal episode




        
Axial T2 and FLAIR                                                                           


   
T1 sagittal noncontrast and axial postcontrast                                                                                      


 
Axial FLAIR and DWI



Findings:

Hyperdense mass with hyperostosis on NECT
Homogeneously enhancing extra-axial dural based mass
Cortical buckling and trapped cortical vessels


DDX:

Cystic brain tumors:  pleomorphic xanthoastrocytoma (PXA), pilocytic astrocytoma, hemangioblastoma,  ganglioglioma/gangliocytoma
Metastases (particularly squamous cell and adenocarcinoma)
Abscess particularly echinococcus if thin wall



Diagnosis:

Metastasis from squamous cell carcinoma of lung



Discussion:

Although an abscess or primary tumor could not be excluded, the thin rim of enhancement and patient age with moderate surrounding edema favor a cystic metastasis.



Submitted by John Rhee, MD, UW Neuroradiology Fellow

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