Presentation
A known case of breast cancer under follow-up with a history of the right frontal space-occupying lesion.
Patient Data
Previous MRI since 11 months back was reviewed and compared.
Again with no significant interval changes, there is a well-defined solitary small extra-axial dural-based right frontal lesion with dural tail sign measuring about 1.0 x 0.7 cm in cross-section dimension, reflecting isointense to gray matter in T1WI and mild hyperintense in T2WI with homogeneous post-contrast enhancement, exerting compression mass effect on the adjacent right frontal lobe with no adjacent edema or restricted diffusion likely typical meningioma.
Mild mucosal thickening was seen in right frontal, ethmoid and sphenoid sinuses with an unremarkable visualized skull.
Impression
Stationary right frontal extra-axial dural-based small enhancing lesion likely representing a small meningioma rather than a metastasis.
A small extra-axial lesion seen in the right frontal region with avid homogeneous post-contrast enhancement could be metastasis versus meningioma. For further evaluation with MRI.
Case Discussion
This case was diagnosed with right breast cancer under work-up staging by CT showing;
An incidental right frontal lesion was seen in the CT brain, suggesting metastasis versus meningioma
Subsequent MRI was performed and excluded other lessons
A follow-up MRI after 1 year showed no significant changes and a stationary right frontal extra-axial, dural-based small enhancing lesion likely representative of small meningioma rather than a metastasis.
Meningioma is a common and often incidental tumor that usually enhances avidly on post-contrast imaging, as in our case (T1-weighted post-contrast image).
A characteristic finding in meningiomas is the presence of some enhancing tumor extending away from the mass along the dura, called a ‘dural tail’ (arrow).
On CT, meningiomas are often hyperdense on non-contrast imaging, and frequently contain some calcification. In this patient’s case, the meningioma is causing a minimal mass effect on the adjacent frontal lobe.
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