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 hyper intense in T2WI with homogeneous post contrast enhancement, exerting compression mass effect on the adjacent right frontal lobe with no adjacent oedema or restricted diffusion likely typical meningioma.
Mild mucosal thickening was seen in right frontal, ethmoid and sphenoid sinuses with unremarkable the visualised skull.
Impression
Stationary right frontal extra axial dural based small enhancing lesion likely representing small meningioma rather than being a metastasis.
A small extra-axial lesion seen in the right frontal region with avid homogeneous post contrast enhancement could be metastasis versus menienfgioma, for further MRI.
Case Discussion
This case was diagnosed with right breast cancer under work up staging by CT showing;
- An incidentally noted right frontal lesion as seen in the CT brain and suggesting metastasis versus meningioma and advised MRI then MRI was done and excluded other lessons and still on the previous suggestion of metastasis versus meningioma.
- A follow-up MRI after about 1 year showing no significant changes and stationary right frontal extra axial dural based small enhancing lesion likely representing small meningioma rather than being a metastasis.
Meningioma is a common and often incidental tumour usually enhance avidly on post-contrast imaging, as our case (T1-weighted post-contrast image).
A characteristic finding in meningiomas is the presence of some enhancing tumour 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 a lot of calcification. In this patient’s case, the meningioma is causing a minimal mass effect on the adjacent frontal lobe.
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