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Man undergoing neurological workup.

Our appreciation is extended to Dr. Anwar Ashraf,
Indiana University Department of Radiology,
for contributing this case.

History:  Man undergoing neurological workup.
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Which choice best characterizes the location of the salient abnormality?

Posterior fossa (extra-axial).Falx.Third ventricle.Orbit(s).Basilar cisterns.
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Man undergoing neurological workup.

The most salient CT image is shown below. An image from a CT one year prior is shown on the R. Click to enlarge.

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Can you select the actual diagnosis?

Aneurysm.Meningioma.Ependymoma.Colloid cyst.Low-grade glioma.
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Man undergoing neurological workup.

Image
Findings:  Non-contrast CT demonstrating round circumscribed iso-to-hyper dense extra-axial mass within the foramen of Monro. No evidence of obstructing hydrocephalus or transependymal flow. Very little if any change over one year.


Differential diagnosis:

  • Colloid cyst
  • Meningioma
  • Choroid plexus papilloma
  • Hamartoma
  • Glioma
  • Vascular lesion
  • Granulomatous disease
Diagnosis:  Colloid cyst
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Man undergoing neurological workup.


Key points:
 

  • Colloid cyst:  A unilocular mucin-containing cyst (may contain hemorrhage, cholesterol crystals, water)
  • 99% are found wedged in 3rd ventricle
  • Majority are hyper dense on non-contrast CT; Density correlates inversely with hydration state (e.g., the more water content, the less dense on CT)
  • Rim enhancement has been seen, but it is considered rare, and if present, an alternative diagnosis should be considered
  • MRI shows variable intensity on T1/T2, secondary to variable composition
  • 40-50% are asymptomatic, typically incidental finding
  • Incidence: M=F, arises usually 3rd-4th decade
  • Most can be monitored by serial imaging, as 90% remain stable without enlargement
  • Complications: Acute hydrocephalus >herniation>death secondary to obstruction of Foramen of Monro
    • Classically presents as acute severe headache, reproduced by patient tilting head forward (Brun phenomenon)
  • Treatment: Complete surgical resection

References:

  1. "Fundamentals of Diagnostic Radiology, 3rd Edition." W.E. Brant, C.A. Helms. 2007. 
  2. StatDx, Sept 15, 2011
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Man undergoing neurological workup.


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