Lateral Ventricular Mass
Bernadette L. Koch, MD
DIFFERENTIAL DIAGNOSIS
Common
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Choroid Plexus Cyst
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Intraventricular Hemorrhage (IVH)
Less Common
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Subependymal Giant Cell Astrocytoma
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Ependymal Cyst
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Choroid Plexus Papilloma
Rare but Important
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Choroid Plexus Carcinoma
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Meningioma
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Langerhans Cell Histiocytosis
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Central Neurocytoma
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Subependymoma
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Ependymoma
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
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Choroid Plexus Cyst
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Key facts
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Most common intraventricular mass in children and adults
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Any age; adults > > children
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Frequently bilateral
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Usually incidental; rarely large enough to
obstructive hydrocephalus -
Lateral ventricle > > > 3rd ventricle
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Imaging findings
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Cyst within or attached to choroid plexus
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CE cyst wall and surrounding choroid
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Hyperintense FLAIR and DWI common
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± irregular peripheral calcifications
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Xanthogranuloma = laden degenerative cyst; more common in adults
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Intraventricular Hemorrhage (IVH)
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Key facts
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2° to germinal matrix hemorrhage, trauma, tumor, or vascular malformation
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Imaging findings
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Intraventricular hemorrhage initially hyperechoic and hyperdense
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± dependent fluid-fluid level
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± clotted blood adherent to choroid plexus
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May → ventriculitis &/or hydrocephalus
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Post-traumatic IVH: Frequently with SAH, and usually sequelae of severe injury
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Helpful Clues for Less Common Diagnoses
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Subependymal Giant Cell Astrocytoma
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Key facts
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Present in 15% of patients with tuberous sclerosis complex
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Imaging findings
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Heterogeneously enhancing mass near foramen of Monro
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± calcifications
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+ intraparenchymal hamartomas
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± obstructive hydrocephalus
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± globe hamartomas
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Enhancement alone does not allow discrimination from hamartoma
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Growth suggests subependymal giant cell astrocytoma rather than hamartoma
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MRS: Less than expected ↓ NAA due to neuronal elements in tumor
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Ependymal Cyst
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Key facts
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Synonym: Neuroepithelial cyst
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Congenital, benign ependymal-lined cyst
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Intraventricular, central WM of temporoparietal and frontal lobes, subarachnoid space, mesencephalon
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Imaging findings
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Lateral ventricle > > > 3rd and 4th ventricle
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Nonenhancing, thin-walled cyst
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Round or multiseptated
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Similar to CSF on all imaging
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± hyperintensity on T2WI and FLAIR
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Choroid Plexus Papilloma
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Key facts
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Lateral > 3rd and 4th ventricle in children
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4th ventricle most common site in adults
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Usually < 1 year of age at diagnosis
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Males > > > females
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Rarely bilateral
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Usually present with hydrocephalus secondary to obstruction, CSF overproduction by tumor or hemorrhage
impaired CSF resorption -
Differentiation from choroid plexus carcinoma is histologic, not radiologic
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Imaging findings
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Helpful Clues for Rare Diagnoses
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Choroid Plexus Carcinoma
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Key facts
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≈ always in lateral ventricle
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Usually 3-5 years of age
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Males = females
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Usually present with hydrocephalus ± focal neurological deficits related to local brain invasion
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Imaging findings
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Heterogeneous mass with irregular margins + parenchymal invasion ± surrounding edema
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Cysts, hemorrhage, and necrosis common
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MRS: Absent NAA and Cr/PhCr peak; higher choline peak than papilloma + increased lactate
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± CSF metastasis
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Meningioma
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Key facts
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Lateral ventricle atrium most common site; left > right
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Uncommon in children; consider NF2
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Pediatric meningiomas: More frequently large, cystic, rapidly growing, and malignant vs. adult disease
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Imaging findings
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Lobular, intensely enhancing intraventricular mass
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± calcification ± cysts, hemorrhage
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Heterogeneity or indistinct margins favor higher degrees of malignancy
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Langerhans Cell Histiocytosis
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CNS involvement = pituitary infundibulum, parenchymal, dural, or choroid plexus
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