2 y/o boy with decrease LOC

 

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Doctor's Information

Name : Zohreh
Family : Rohani
Affiliation :Zahedan Radiology Department,imam Ali Hospital,
Academic Degree : Asssiatant professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mohsen Hasanzadeh

 

Case Section

Pediatric Radiology

 

Patient's Information

Gender : Male
Age : 2

 

Clinical Summary

2 y/o boy with decrease LOC and raccon eye

 

Imaging Findings

MRI images releaved iso-tense T1 and mildy hypertense T2( in contrast to gray matter) dural and epidural based masses with pressure effect on brain cortex and inward displacement of saggital sinus and also extra conal orbital masses supra renal huge mass is seen in abd CT Scan

 

Differential Diagnosis

Epidural or dural metastasis is most often secondary to carcinoma of the breast, lymphoma, carcinoma of the prostate, and neuroblastoma.Other common sources are carcinomas of the lung and kidney.

 

Final Diagnosis

neuroblastoma

 

Discussion (Related Text)

Metastases to the Skull and Intracranial Dura Metastasis to the cranial vault or the base of the skull is associated with intracranial metastasis in 5% to 10% of cases. 156,32H8ematogenous metastasis to the calvarial diploe often leads to destruction of the internal and external tables and extension of tumor into the adjacent epidural space. In one autopsy series of patients with primary extracranial malignancy and intracranial metastasis, 18% demonstrated dural involvement (induding epidural or subdural neoplasm) as the only site of intracranial metastasis. 12,306Occasionally, dural metastasis may occur without an associated calvarial lesion, either as a nodular plaquelike focus or as a more extensive diffuse thickening of the dura.89,265Epidural or dural metastasis is most often secondary to carcinoma of the breast, lymphoma, carcinoma of the prostate, and neuroblastoma.306 Other common sources are carcinomas of the lung and kidney.12 Although the dura is usually an effective barrier to further deep invasion, spread of tumor in the epidural space with nodular or band like soft tissue thickening is common. Symptoms usually relate to compression of the underlying brain parenchyma. 12 Irregularly marginated focal osseous destruction of the bony calvaria or the skull base caused by metastasis to the diploe or marrow can be best defined on noncontrast cr scans obtained through the use of a bone-targeting algorithm with wide window and high center settings.273 Destruction of the inner table of the skull allows extension of tumor into the intracranial epidural space, which can be demonstrated on cr scans obtained after intravenous administration of iodinated contrast medium with the use of a soft tissue algorithm and appropriate ("subdural window") soft tissue window and center settings. These tumors typically demonstrate intense contrast enhancement, but recognition of the contrast-enhancing biconvex epidural tumor mass can be masked by the adjacent bone unless relatively wide window and high center settings are used. In current practice, early detection of small metastases in the diploe or in the dura can best be accomplished by using T1-weighted MR images both before and after intravenous administration of gadolinium.]2 Small foci of intradiploic metastasis appear hypointense on noncontrast T1-weighted images and differ sharply from the adjacent hyperintense fatty marrow in the diploic space (Fig. 2-66). Postgadolinium T1-weighted images obtained with fat suppression typically demonstrate intense contrast enhancement of tumor in the epidural space or dura, which appears as nodular or curvilinear bandlike thickening (see Fig. 2- 66); the underlying cerebral cortex is displaced inward, and (unlike leptomeningeal metastasis) the contrast-enhancing tumor does not extend into the cerebral sulci.362The findings may simulate those of meningioma, but epidural or dural metastasis typically appears hyp

 

References

CT and MRI of the Whole Body,haaga p 133

 

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