En plaque meningioma - sphenoid wing

Case contributed by Mostafa Elfeky
Diagnosis probable

Presentation

Left proptosis.

Patient Data

Age: 40 years
Gender: Female
This study is a stack
Axial
T1
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Axial
T2
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Axial
FLAIR
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Sagittal
T1
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Coronal T2
fat sat
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Axial T2
fat sat
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Axial
T1
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Coronal
T1
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Sagittal
T1
This study is a stack
Axial T1
C+ fat sat
This study is a stack
Coronal T1
C+ fat sat
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Axial
T1 C+
This study is a stack
Sagittal
T1 C+
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
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Info

Thickening of the left greater wing of sphenoid bone with low signal on T1 and T2, absent normal fat marrow and roughness of its surfaces reflecting hyperostosis. There are middle cranial fossa epidural and lateral orbital wall subperiosteal soft tissue components with post-contrast enhancement. Enhancing temporal dural tail is noted.

The lesion is encroaching upon orbital apex and exerting a mass effect on retrobulbar left orbital structures resulting in proptosis and stretching of lateral rectus muscle.

There is tight compression upon the left optic nerve at the level of orbital apex due to narrowing of optic canal.

Case Discussion

MRI features of en plaque meningioma. It is a rare tumor that commonly affects the sphenoidal ridge. It infiltrates the dura and bone, with resultant hyperostosis. It results in inward bowing and thickening of lateral orbital wall with extraconal soft tissue component encroaching upon retrobulbar structures and resulting in proptosis. It has more malignant potential than usual meningioma.

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