Presentation
Work up pre-surgery for CT abnormality.
Patient Data
There is a right sided parafalcine extraaxial mass measuring 1.5cm in diameter. It appears to arise from the dura at the junction between parietal bone and superior sagittal sinus/falx. It indents the underlying parietal lobe, without adjacent parenchymal edema. The center of the mass is of low signal on all sequences, consistent with mineralization. Although the mass abuts the superior sagittal sinus it does not appear to narrow or invade it. The dural venous sinuses appear unremarkable.
Incidental note is made of prominent choroidal xanthogranulomas.
Single image through the lateral ventricles, demonstrates near-CSF attenuation cystic structures in the trigones consistent with choroid plexus granulomas. Flecks of calcium are scattered around their periphery.
The small parafalcine meningioma (green arrow) is seen abutting the superior sagittal sinus.
Incidental choroid plexus xanthogranulomas are seen (yellow dotted lines) as hypodense (on CT) and high T2 signal lesions (on MRI) with no significant enhancement and vivid high signal on DWI.
Case Discussion
Typical appearances of a meningioma and incidental choroidal xanthogranulomas. The latter are often not noticed by junior radiologists or clinicians on hundreds of scans. One day they are noticed, especially if unilateral and are then the source of anxiety and misdiagnosis. As such, knowledge of them is useful.
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