Sphenoid wing en plaque meningioma

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Right temporal swelling, headache with mild right orbital proptosis.

Patient Data

Age: 36 years
Gender: Female
Modality: CT

A well defined sclerotic lesion is seen involving and notably expanding the right orbital roof, the lateral orbital wall, and greater wing of the right sphenoid bone with homogeneous sclerosis. It is seen encroaching upon the right orbital cavity, indenting and medially displacing the lateral rectus muscle with mild anterior protrusion (proptosis) of the right eye globe. No other calvarial or skull base mass lesions.

Modality: MRI
  • The greater wing of the right sphenoid bone as well as the right lateral orbital wall and the orbital roof show expansion by a well- defined lesion of dark signal on all pulse sequences; the lesion measures about 3.9 X 3.3 X 3.7 cm in its maximal axial and cranio-caudal dimensions. It is seen indenting the posterior and lateral orbital wall, displacing the right lateral rectus muscle antro-medially with mild right proptosis. Mild homogeneous enhancement of the entire sclerotic lesion is noted with evident moderate homogeneous contrast enhancement of a small right anterior temporal extra-axial meningeal sheet is noted in post gadolinium series.
  • No other calvarial or skull base or intra-axial enhancing masses.
  • Otherwise, unremarkable MRI examination of the brain and orbits. 

Case Discussion

Right sphenoid bone greater wing as well as right lateral orbital wall and orbital roof sclerotic lesion with mild homogeneous enhancement and enhancing extra-axial right anterior temporal dural tail; impressive of hyperostosing en plaque meningioma.

The differential diagnosis is:

  • Fibrous dysplasia of the sphenoid bone: bone expansion with ground glass attenuation, usually ill-definition of the boundary between the craniofacial bones with fibrous dysplasia and the normal bones. Heterogeneous enhancement with no enhancing dural tail. 
  • Metastatic deposit: Usually a known primary, with more intense enhancement and other brain, calvarial or skull base lesions.

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Case Information

rID: 42082
Case created: 5th Jan 2016
Last edited: 15th Jan 2016
Inclusion in quiz mode: Included

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