Radiological Category Neuroradiology Principal Modality 1 CT Principal

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Radiological Category: Neuroradiology Principal Modality (1): CT Principal Modality (2): none Case Report #0234

Radiological Category: Neuroradiology Principal Modality (1): CT Principal Modality (2): none Case Report #0234 Submitted by: Clare Savage, M. D. Faculty reviewer: Leo Hochauser, M. D. Date accepted: 25 July 2005

Case History A 49 -year-old female presented to the emergency room with increasing frequency

Case History A 49 -year-old female presented to the emergency room with increasing frequency and severity of headaches. The patient’s past medical history was remarkable for hypertension, which was well controlled with medications. The past surgical history was remarkable for a prior cholecystectomy and appendectomy. After a non-contributory physical exam, a non-contrast head CT was obtained followed by an MRI.

Radiological Presentations Non-contrast CT of the brain shows a dense left trigone mass

Radiological Presentations Non-contrast CT of the brain shows a dense left trigone mass

Radiological Presentations Non-contrast CT of the brain shows a dense left trigone mass

Radiological Presentations Non-contrast CT of the brain shows a dense left trigone mass

Radiological Presentations Post-contrast T 1 weighted MRI in the coronal plane shows an enhancing

Radiological Presentations Post-contrast T 1 weighted MRI in the coronal plane shows an enhancing left trigone mass

Radiological Presentations Post-contrast T 1 weighted MRI in the axial plane shows an enhancing

Radiological Presentations Post-contrast T 1 weighted MRI in the axial plane shows an enhancing left trigone mass

Test Your Diagnosis Which one of the following is your choice for the appropriate

Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page. • colloid cyst • metastasis • meningioma • hemorrhage

Findings and Differentials Findings: A non-contrast enhanced CT of the brain demonstrates a hyperdense,

Findings and Differentials Findings: A non-contrast enhanced CT of the brain demonstrates a hyperdense, partially calcified mass in the left trigone. No hydrocephalus is present. There are no additional intracranial masses. Post-contrast MRI shows a uniformly, enhancing mass in the left trigone. Differentials: • meningioma • choroid plexus papilloma • astrocytoma

Discussion Meningioma is the most common trigonal mass after the first decade, with the

Discussion Meningioma is the most common trigonal mass after the first decade, with the greatest incidence after the fifth decade. Overall, meningiomas comprise 15 -18% of intracranial tumors with 0. 5 -3% occurring within the ventricles. Of these intraventricular menigiomas, 80% are found in the lateral ventricle, with a predilection for the trigone. Meningiomas are consistently hyperdense on non-contrast CT with strong enhancement on post-contrast exams. Approximately 50% of meningiomas are calcified. On the current exam, the CT demonstrates a well defined lobular, hyperdense mass with calcifications in the trigone of the lateral ventricle in an adult female, consistent with a meningioma. Post contrast MRI shows uniform enhancement of the mass. Choroid plexus papillomas are iso- or slightly hyperdense in CT, with strong contrast enhancement. Supratentorial tumors are usually seen in younger patients, with one series reporting a mean age of 9 months [1]. Intraventricular astrocytomas are frequently cystic, appearing slightly hyperdense on non-contrast sudies with enhancement following contrast. Astrocytomas that occur within the ventricles are usually low grade and well circumscribed. References: [1] Mc. Conachie NS, Worthington BS, Cornford EJ, et al. Review article: Computed tomography and magnetic resonance in the diagnosis of intraventricular cerebral masses. British Journal of Radiology 1994; 67(795): 223 -243.

Diagnosis The non-contrast CT of the brain shows an intraventricular meningioma of the left

Diagnosis The non-contrast CT of the brain shows an intraventricular meningioma of the left trigone. The post-contrast MRI images show a trigonal mass with uniform contrast enhancement.