When a brain lesion necessitates chest CT

Brain lesions as heralding manifestations of systemic disease can pose a diagnostic problem, particularly when other organ system involvement is not apparent and neuroimaging is nonspecific. Computerized tomography (CT) may identify additional lesion sites. However, when chest roentgenogram is negative chest CT is not routinely considered. A patient is presented in whom chest CT led to lung biopsy and diagnosis of cerebral cryptococcoma when clinical and neuroimaging features were nonspecific, and chest x-ray and serology were negative. We suggest that chest CT is warranted in patients with abnormal brain imaging not typical of a primary brain process, even in the presence of a negative chest x-ray.