Presentation
Headaches and dizzy
Patient Data
Right choroid lesions demonstrate a high signal on DWI, and a low signal on ADC images; a low signal on T1, a high signal on T2 weighted imaging, not suppression on FLAIR.
Case Discussion
The cystic-like lesions and diffusion restriction of the choroid plexus has a differential diagnosis of choroid plexus xanthogranuloma, infarction of the choroid plexus, choroid cyst, intraventricular hemorrhage, pyogenic ventriculitis.
Choroid cysts can follow CSF on all sequences and no restricted diffusion on DWI.
Intraventricular hemorrhage: lesion's incomplete CSF FLAIR signal suppression but has not to signal to drop out on T2* and hematocrit fluid-fluid levels.
Pyogenic ventriculitis can restrict diffusion but has no layering debris in the ventricle and no sign of infection.
Infarction and xanthogranuloma of the choroid plexus have both restricted diffusion on DWI. Infarction is usually unilateral whereas xanthogranuloma is usually bilateral. But infarction associate with another infarction in the same vascular territory and this patient has no sign of stroke.
Choroid plexus xanthogranulomas are benign, asymptomatic, and incidentally found, usually located in lateral and third ventricles. Signal characteristics on MRI are variable depending on the mixture of lipid, fluid, and blood products. They mimic cystic lesions but do not fully attenuate on FLAIR. The symptoms, and imaging characteristics consistent with xanthogranuloma.
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