PMC8035493_01
Timeline of major disease-related events and representative images of head imaging. (a) A schematic timeline displayed the major events during disease progression. (b) The initial head CT revealed extensive iso-dense and several hyperdense ill-defined masses. (c) CE-MRI identified diffuse T1 gadolinium-positive (T1 Gd+) lesions. Several high signals on T1 image indicated ITH, and typically hyperintense metastases were identified without significant mass effects. (d) There was negative finding on head CT imaging when the patient was diagnosed with DVT. (e) The last head CT showed diffuse open-ring or hollow circles of hyperintensities with sulci effacement, compatible with diffuse hemorrhagic metastases. The white arrow pointed to a same hemorrhagic metastasis.
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Only sporadic minor peritumoral edema and ITH or calcification were observed at the initial CT scan (Figure 1b). Sporadic hemorrhagic other than calcified metastases were confirmed on T1, which was indicated by intrinsic high signal (Figure 1c). A head CT was scheduled and no hemorrhagic BMs was identified (Figure 1d). The head CT scan confirmed the diagnosis and revealed the extensive but separate foci of intraparenchymal hemorrhage and general brain swelling (Figure 1e).