Department of Pulmonology, Hospital de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
Int J Clin Oncol. 2011 Dec;16(6):746-50. doi: 10.1007/s10147-011-0221-7. Epub 2011 Mar 25.
The authors describe a case of a 47-year-old male smoker with a 3-month history of hearing loss, tinnitus and dizziness. Physical examination revealed neurosensory hearing loss. Small rounded hypodensities without mass effect were evident in a computed tomography scan of the head, confirmed by brain magnetic resonance imaging as multiple cystic lesions in both cerebral and cerebellar hemispheres, without perilesional edema or gadolinium enhancement, suggestive of neurocysticercosis. Extraparenchymal involvement was also noted. Albendazole and dexamethasone were started. As a chest radiograph showed a bilateral reticulonodular pattern, a bronchoscopy was performed showing normal results. However, transbronchial biopsy revealed lung adenocarcinoma. Thoracoabdominopelvic computed tomography scan showed secondary lung and bone lesions. Since brain lesions were not suggestive of secondary tumor lesions, a brain biopsy was performed confirming metastatic disease. This case illustrates some peculiar imagiological features of brain metastases in lung cancer, indicating that sometimes invasive procedures are required to establish a definitive diagnosis.
作者描述了一例 47 岁男性吸烟者，有 3 个月听力损失、耳鸣和头晕病史。体格检查发现为感音神经性听力损失。头部计算机断层扫描显示小而圆形的低密度影，无肿块效应，脑部磁共振成像证实双侧大脑和小脑半球存在多个囊性病变，无周围水肿或钆增强，提示神经囊虫病。也注意到外实质受累。开始使用阿苯达唑和地塞米松。由于胸部 X 光片显示双侧网状结节状模式，因此进行了支气管镜检查，结果正常。然而，经支气管镜活检显示肺腺癌。胸腹盆计算机断层扫描显示继发性肺和骨病变。由于脑部病变不提示继发性肿瘤病变，因此进行了脑部活检以确认转移性疾病。该病例说明了肺癌脑转移的一些特殊影像学特征，表明有时需要进行有创性操作以明确诊断。
