Right sided hearing loss. History of previous intervention for hydrocephalus.
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A large right cerebello-pontine angle mass lesion is seen, it shows heterogenous hypointense T1 and hyperintense T2 signal with central necrosis. The lesion shows intense heterogenous post-contrast enhancement with small intra-canalicular extension. It measures 6 X 4.5 X 3.8 cm in its main axial and CC dimensions and is seen surrounded by mild vasogenic brain oedema with compression of the right cerebellar hemisphere and downward displacement of the cerebellar tonsils, right pons and brachium pontis as well as the 4th ventricle with associated mild supratentorial hydrocephalus.
A right sided shunt tube is seen with its tip in the right lateral ventricle.
A large right CPA mass lesion; diagnostic of acoustic schwannoma with supratentorial hydrocephalus and tonsillar herniation. The patient was urgently referred to the neurosurgical department.