IMAGES IN EMERGENCY MEDICINE
Ring enhancing lesion on CT scan: metastases or a brain abscess?
City Hospital, Birmingham, UK
Correspondence to:
Dr Anil Kumar Agarwal, City Hospital, Birmingham, UK; anilbaliuk@yahoo.co.uk
Accepted 6 September 2006
| The first 150 words of the full text of this article appear below. |
A 28-year-old man presented to eye casualty with left orbital headache. The physical examination was normal but fundoscopy showed left sided papilloedema. There were no features indicative of infection/sepsis, and no history of primary malignancy. Blood results were not suggestive of infective pathology. Computed tomographic (CT) brain scan showed multiple ring enhancing lesions, suggestive of multiple cerebral metastases and/or brain abscess (
figs 1 and 2). Brain biopsy on immunohistochemistry staining using Melan-A and HMB45 showed melanin pigment within disorderly arranged cells, confirming the diagnosis of malignant melanoma (fig 3).
Figure 1 CT scan brain showing ring enhancing lesions.
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Figure 2 CT scan brain showing ring enhancing lesions.
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Figure 3 Melanin pigment in metastatic malignant melanoma on immunohistochemistry using Melan A staining.
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Malignant melanoma was diagnosed when our patient presented with cerebral metastases. In 70–80% cases of melanoma recurrence, metastases are seen in the brain. Cerebral metastases in melanoma have prognostic value.1 The
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