Pachymeningeal metastasis from breast cancer

Case contributed by Chris O'Donnell
Diagnosis probable


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

Patient Data

Age: 50 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

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

Bone scan

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 tumor 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.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.