Metastatic rhabdomyosarcoma presenting as intracranial hemorrhage: imaging findings

The CNS is rarely the first site of metastasis for rhabdomyosarcoma. CNS involvement is uncommon, and usually seen as leptomeningeal spread after development of pulmonary metastases. We present the imaging findings in a 13-year-old boy in whom a large intracranial hemorrhage was the initial presentation of surgically documented metastatic prostatic rhabdomyosarcoma. Multiple chest CTs and radionuclide bone scans had previously shown no evidence of pulmonary or osseous metastases. The significance of this case in relation to the possible role of the need for use of chemotherapeutic agents that cross the blood-brain barriers to prevent brain metastasis is discussed.