Hemorrhage in metastatic neoplasms-CT

Multifocal haemorrhagic ring lesions  with vasogenic edema, possibly haemorrhagic mitotic etiology (likely secondaries).  Note- The incidence of hemorrhage in metastatic neoplasms is highest in melanoma, hypernephroma, bronchogenic carcinoma, and choriocarcinoma. Other metastatic tumours that bleed are breast and thyroid metastasis

Spinal metastasis-MRI

This is MRI lumbar spine of a 70 yr old male who came to us with complaints of back pain and pain in both lower limbs. It shows evidence of osseous destruction along with marorw signal abnormality of multifocal vertebral bodies involving all lumbar vertebral bodies, sacral ala. There is epidural soft tissue component with involvement of the posterior elements, appearing heterogeneously hyperintense on STIR and hypointense on T1W along with compromise of neural sac.
Discussion:
Four MR patterns of vertebral metastatic disease are seen – focal lytic, focal sclerotic, diffuse inhomogenous, diffuse homogenous. The most common among them is focal lytic lesions characterized by low signal intensity on T1 and high on T2. Pedicle destruction is more in favour of metastatic etiology. Pathologic compression fractures are also seen and show comparatively low signal intensity on T1 and high signal on T2 as compared to benign osteoporotic fractures which are mostly isointense on all sequences.

Case by Teleradiology providers

Pulmonary Secondaries- from Testicular tumour

This is a 24 yr old man presented with cough with hemoptysis and CT chect was done to look for the cause. CT chest was done and revealed mutliple coin lesions suggesting metastatis. It was suggested back to the clinician and we asked if there was any scrotal mass. Resident was not aware as he was neurology resident. On our request a complete examination was done and revealed a large testicular tumour which the patient was not informing.

Lesson learnt-there is still a lot of place for complete clinical examination.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)