Presentation
Patient with intraventricular tumour detected on CT and underwent MRI for further assessment. The patient had renal failure and no contrast was given.
Patient Data
An ill defined soft tissue mass is seen centred on the 4th ventricle obliterating its cavity and extends through foramen of Magendi posterior to the pons and medulla oblongata. It squeezes into the aqueduct of sylvius and extends to the 3rd then through foramina of Monro to frontal horns of both lateral ventricles as well as the suprasellar and prepontine cisterns. MRS reveals striking elevation of Cho peak with Cho/Cr ratio of 6.5 with marked reduction of NAA peak and small traces of lipid and lactate.
Case Discussion
Such squeezable mass is suggestive of ependymoma which was confirmed by biopsy that revealed WHO grade II ependymoma. Ependymoma is a plastic tumour that has the capability to squeeze through foramina and reaches other CSF spaces.
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