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Case Challenge: Brain Tumors MRI Cases


Case Review Power Pack – Brain Tumors Pre-Course Activities
1 topic
Brain Tumors, Vol. 1
20 topics | 10 quizzes
Course Evaluation
1 topic

5b - Answer: 50-year-old female presents with known meningioma

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 50-year-old female presents with known meningioma for the last eight years. No history of trauma. Patient complains of increasing left-sided head pain over the last several months.

(QUIZ ANSWER) IN THIS CASE, THE MASS HAS: 

Stayed the same in size.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

COMPARISON:

Comparison MR from approximately two years prior.

FINDINGS:

A 1.2 x 1.2cm enhancing dural-based extra-axial mass is again seen in the left frontal region, consistent with previously diagnosed small meningioma. It has not changed significantly in size or appearance since the exam of two years prior. There is no associated parenchymal edema or increased mass effect on the brain. There is no evidence of new enhancing lesion.

A small multi-lobular focus of encephalomalacia with surrounding gliosis is again seen in the right posterior temporal lobe. It shows no enhancement, mass effect, or significant interval change since two years prior.

Multiple tiny T2 white matter hyperintensities are again noted, also unchanged since the last study.

There is no evidence of acute intracranial hemorrhage, mass effect or midline shift. Ventricles and basilar cisterns are stable in configuration. Gray-white matter interfaces are stable. Posterior fossa is unremarkable without evidence of Chiari malformation. There is no evidence of cerebellopontine angle lesion. 7th / 8th nerve complexes are within normal limits. The pituitary gland and sella are unremarkable. Orbits and their contents are unremarkable. Paranasal sinuses are unremarkable. 

A 6mm well circumscribed rounded lesion is seen in the posterior aspect of the left mastoids, low on T1 and high on T2. It was not present at the time of the last exam. It most likely represents retained fluid. Both mastoids are otherwise well aerated and unremarkable. 

All major arterial and venous flow voids are visualized and unremarkable. 

CONCLUSION: 

1. 1.2 x 1.2 cm left frontal meningioma, unchanged in appearance since two years prior. 

2. 1 cm focus of multilobulated encephalomalacia and surrounding gliosis in the posterior right temporal lobe, unchanged in size or appearance since two years prior. 

3. Multiple small rounded T2 white matter hyperintensities, stable since last exam. These likely represent chronic sequelae of small vessel arteriopathy or venopathy. 

4. Minimal retained fluid in posterior left mastoid air cells, new since last exam. 

5. No other significant interval changes since two years prior.

LESSON 2, TOPIC 15

Case Challenge: Brain Tumors MRI Cases

Case Challenge

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Content reviewed: November 3, 2021

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