Pachymeningeal metastasis from breast cancer

Case contributed by Dr Chris O'Donnell

Presentation

Past history of carcinoma of the breast. Now right hand numbness.

Patient Data

Age: 50
Gender: Female
Modality: CT

Pre and post contrast imaging performed but only post contrast images shown.

Subtle but definite enhancing extra-axial mass overlying the left frontal lobe

MRI brain

Modality: MRI

MRI shows a more extensive smooth but variable thickness dural enhancement/mass overlying the left hemisphere with mass effect

Bone scan for staging of cancer

Modality: Nuclear medicine

Note subtle but definite abnormal isotope accumulation in the left fronto-parietal region at the site of dural thickening

Case Discussion

Dural or pachymeningeal metastases are rare.  Breast and prostate cancer are the most likely primary sites.  As in this case, MRI shows much more extensive dural thickening than CT. 

Always be aware that such tumour can obstruct cortical veins or major venous sinuses leading to venous infarction.   The major differential is obviously meningioma but should include an infective process such as TB as well as post-operative change following craniotomy.  

Spontaneous intracranial hypotension causes smooth bilateral dural thickening.   Extra-axial collections may enhance around the rim but not within the central fluid.

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Case Information

rID: 19438
Case created: 9th Sep 2012
Last edited: 27th Aug 2016
Inclusion in quiz mode: Included

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