Hyperdense Extra-Axial Mass(es)
Miral D. Jhaveri, MD
DIFFERENTIAL DIAGNOSIS
Common
Subdural Hematoma, Acute
Epidural Hematoma
Meningioma
Metastases, Meningeal
Less Common
Thrombosis, Dural Sinus
Thrombosis, Cortical Venous
Neurosarcoid
Lymphoma, Metastatic, Intracranial
Tuberculosis
Dural A-V Fistula
Rare but Important
Extramedullary Hematopoiesis
Leukemia
Venous Varix (Isolated)
Hemangiopericytoma
Malignant Nonmeningothelial Tumors
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Is it hemorrhage?
Or is it hyperdense mass(es) masquerading as hemorrhage?
CECT/T1 C+ MR helpful in differentiating between the two
No contrast-enhancement → hemorrhage
Contrast-enhancement within hyperdense mass excludes simple hemorrhage
Helpful Clues for Common Diagnoses
Subdural Hematoma, Acute
NECT: Homogeneously hyperdense crescent-shaped extra-axial collection
May cross sutures, not dural attachments, may extend along falx & tentorium
Epidural Hematoma
NECT: Hyperdense biconvex extra-axial collection in acute phase
Does not cross sutures unless sutural diastasis/fracture, can cross falx & tentorium
Meningioma
70-75% hyperdense on NECT, sharply circumscribed smooth mass abutting dura
> 90% enhance homogeneously & intensely on CECT
Metastases, Meningeal
NECT: Hypercellular or hemorrhagic
Skull/dura often/but not always infiltrated
Often known extracranial malignancy
Helpful Clues for Less Common Diagnoses
Thrombosis, Dural Sinus
Hyperdensity along expected location of dural sinuses
May be associated with venous infarcts
Neurosarcoid
Multifocal dural-based foci, presence of leptomeningeal enhancement additional clue
Abnormal CXR, raised ESR, ACE levels
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