• Athena Huynh, Collin Pryma, Heather McPhaden, Karl-Christopher Yared, Yilin Zhang, Katie Beadon, Tony Ng, and Luke Y C Chen.
• Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
• Chest. 2024 Apr 1; 165 (4): e95e100e95-e100.

AbstractA 52-year-old woman with no significant medical history was referred to our hospital for expedited workup of progressive dysarthria and ataxia over the past year. Prior CT angiography of the head and neck showed no relevant neurologic findings but did reveal miliary lesions in the lung apices, which was later confirmed via dedicated CT chest scan (Fig 1). Review of systems was negative for any respiratory, constitutional, or rheumatologic symptoms, except for new xanthelasma-like lesions over her forehead. She previously had smoked with 20 pack-years and had no TB risk factors. MRI of the face showed a 21-mm mass within the left external temporal fascia. MRI of the head showed diffuse leptomeningeal enhancement, right frontal lobe enhancement, and cerebellar and brainstem T2/fluid-attenuated inversion recovery hyperintensity, which prompted her admission to hospital.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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