Hypertrophic pachymeningitis

Last revised by Assoc Prof Frank Gaillard on 26 Feb 2022

Hypertrophic pachymeningitis is a condition where there is localized inflammatory thickening of the dura. On imaging, it presents as a localized, multiple, or diffuse enhancing dural thickening commonly forming mass-like lesions. 

Can have a multitude of presentations. Cranial nerve palsies are common.

It can result from a number of causes which include:

When no cause is identified it is termed idiopathic hypertrophic pachymeningitis.

  • shows localized, or less often, diffuse dural thickening
  • at times can depict mass-like thickening when it is termed tumefactive hypertrophic pachymeningitis 1

Signal characteristics include:

  • T1: thickened areas are hypointense to brain parenchyma on unenhanced T1 images 6
  • T1 C+ (Gd): shows dural enhancement
  • T2: thickened areas are hypointense to brain parenchyma 6

General imaging differential considerations include:

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.