PMC6350275_01
(A) Non-contrast CT Head demonstrates a lesion at the Foramen of Monro causing obstructive hydrocephalus. (B) MRI brain T1 axial study with contrast demonstrates enhancement of lesion at the Foramen of Monro. (C) MRI brachial plexus STIR sequence shows diffuse enlargement with marked T2 hyperintensity of the left brachial plexus.
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F1
CT of the head revealed a third ventricular hemorrhage causing obstructive hydrocephalus (Figure 1A). Monro, with findings concerning for a leptomeningeal neoplastic process (Figure 1B). MRI of the cervical, thoracic, and lumbar spine regions showed contrast enhancement of the C4 through C8 nerve roots. Repeat MRI of the brachial plexus showed enhancement from nerve roots into distal branches in addition to diffuse hyperintensity seen on prior imaging (Figure 1C).
FDG PET coronal (A) and axial (B) sequences show focal hyperactivity at the left pectoral/subpectoral level adjacent to the first rib.
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F2
Given the above findings suggestive of lymphoma, whole body FDG-PET imaging was approved and completed, with evidence of focal activity seen in the left pectoral/subpectoral region adjacent to the first rib in addition to hypermetabolic brain lesions (Figures 2A,B).