Lateral Ventricular Mass

Lateral Ventricular Mass
Bernadette L. Koch, MD
DIFFERENTIAL DIAGNOSIS
Common
  • Choroid Plexus Cyst
  • Intraventricular Hemorrhage (IVH)
Less Common
  • Subependymal Giant Cell Astrocytoma
  • Ependymal Cyst
  • Choroid Plexus Papilloma
Rare but Important
  • Choroid Plexus Carcinoma
  • Meningioma
  • Langerhans Cell Histiocytosis
  • Central Neurocytoma
  • Subependymoma
  • Ependymoma
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
  • Choroid Plexus Cyst
    • Key facts
      • Most common intraventricular mass in children and adults
      • Any age; adults > > children
      • Frequently bilateral
      • Usually incidental; rarely large enough to image obstructive hydrocephalus
      • Lateral ventricle > > > 3rd ventricle
    • Imaging findings
      • Cyst within or attached to choroid plexus
      • CE cyst wall and surrounding choroid
      • Hyperintense FLAIR and DWI common
      • ± irregular peripheral calcifications
      • Xanthogranuloma = laden degenerative cyst; more common in adults
  • Intraventricular Hemorrhage (IVH)
    • Key facts
      • 2° to germinal matrix hemorrhage, trauma, tumor, or vascular malformation
    • Imaging findings
      • Intraventricular hemorrhage initially hyperechoic and hyperdense
      • ± dependent fluid-fluid level
      • ± clotted blood adherent to choroid plexus
      • May → ventriculitis &/or hydrocephalus
      • Post-traumatic IVH: Frequently with SAH, and usually sequelae of severe injury
Helpful Clues for Less Common Diagnoses
  • Subependymal Giant Cell Astrocytoma
    • Key facts
      • Present in 15% of patients with tuberous sclerosis complex
    • Imaging findings
      • Heterogeneously enhancing mass near foramen of Monro
      • ± calcifications
      • + intraparenchymal hamartomas
      • ± obstructive hydrocephalus
      • ± globe hamartomas
      • Enhancement alone does not allow discrimination from hamartoma
      • Growth suggests subependymal giant cell astrocytoma rather than hamartoma
      • MRS: Less than expected ↓ NAA due to neuronal elements in tumor
  • Ependymal Cyst
    • Key facts
      • Synonym: Neuroepithelial cyst
      • Congenital, benign ependymal-lined cyst
      • Intraventricular, central WM of temporoparietal and frontal lobes, subarachnoid space, mesencephalon
    • Imaging findings
      • Lateral ventricle > > > 3rd and 4th ventricle
      • Nonenhancing, thin-walled cyst
      • Round or multiseptated
      • Similar to CSF on all imaging
      • ± hyperintensity on T2WI and FLAIR
  • Choroid Plexus Papilloma
    • Key facts
      • Lateral > 3rd and 4th ventricle in children
      • 4th ventricle most common site in adults
      • Usually < 1 year of age at diagnosis
      • Males > > > females
      • Rarely bilateral
      • Usually present with hydrocephalus secondary to obstruction, CSF overproduction by tumor or hemorrhage image impaired CSF resorption
      • Differentiation from choroid plexus carcinoma is histologic, not radiologic
    • Imaging findings
      • CT: Lobulated, isodense, or hyperdense
      • ± punctate foci calcification
      • T2 hypointense center
      • Intense contrast enhancement
      • MRS: Absent NAA and Cr/PhCr peak, increased lactate secondary to necrosis, not necessarily more aggressive
      • ± CSF metastases
Helpful Clues for Rare Diagnoses
Aug 10, 2016 | Posted by in PEDIATRICS | Comments Off on Lateral Ventricular Mass

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