Lateral Ventricle Mass



Lateral Ventricle Mass


Karen L. Salzman, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Choroid Plexus Cyst


  • Intraventricular Hemorrhage


  • Neurocysticercosis


Less Common



  • Choroid Plexus Papilloma


  • Meningioma


  • Metastasis, Intraventricular


  • Subependymal Giant Cell Astrocytoma (SGCA)


  • Central Neurocytoma


  • Subependymoma


  • Neurosarcoid


  • Ependymal Cyst


Rare but Important



  • Choroid Plexus Carcinoma


  • Ependymoma


  • Cavernous Malformation


  • Lymphoma, Primary CNS


  • Astrocytoma


  • Langerhans Cell Histiocytosis


  • Epidermoid Cyst


  • Teratoma


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Lateral ventricle masses differentiated by



    • Location within lateral ventricle


    • Patient age


Helpful Clues for Common Diagnoses



  • Choroid Plexus Cyst



    • Most common intraventricular mass


    • Arise in choroid plexus glomus, degenerative (xanthogranulomas)


    • All ages (usually older patients)


    • Considered normal variant (40% prevalence); usually bilateral


    • Commonly FLAIR & DWI hyperintense


    • In fetus, consider Trisomy 18 or 21


  • Intraventricular Hemorrhage



    • Typically related to trauma


    • Commonly associated with traumatic SAH


    • May be first presentation of AVM


    • May become Ca++ mass in chronic phase


  • Neurocysticercosis



    • Ventricle is 3rd most common location, after subarachnoid spaces & parenchyma


    • Intraventricular cysts are often isolated, 4th ventricle most common


    • Intraventricular lesions are best seen on FLAIR & T1 MR


Helpful Clues for Less Common Diagnoses



  • Choroid Plexus Papilloma



    • Most common primary intraventricular neoplasm of childhood


    • Top CNS neoplasm in children < 1 y


    • Lateral ventricle atrium most common site


    • Hydrocephalus very common


    • May metastasize throughout CSF


  • Meningioma



    • 1-2% of meningiomas are intraventricular


    • Lateral ventricle atrium most common site, left > right


    • If seen in a child, consider NF2


    • Lobular, strongly enhancing mass


  • Metastasis, Intraventricular



    • Intraventricular metastases much less common than parenchyma, skull/dura, subarachnoid disease


    • Usually lateral ventricle related to choroid plexus, ependyma less common


    • Primary tumor often known


  • Subependymal Giant Cell Astrocytoma (SGCA)



    • Enhancing mass at foramen of Monro in tuberous sclerosis (TS) patients


    • Occurs in 15% of TS patients


    • Often cause ventricular obstruction


  • Central Neurocytoma



    • “Bubbly” mass with enhancement


    • Frontal horn or body of lateral ventricle



      • Typically attached to septum pellucidum


    • Ca++ common, 50-70%


  • Subependymoma



    • T2 hyperintense lobular, nonenhancing intraventricular mass


    • 4th ventricle > lateral > 3rd ventricle


    • Variable enhancement, often none to mild


  • Neurosarcoid



    • Solitary or multifocal enhancing CNS masses with lung disease


    • Dura, leptomeninges, subarachnoid spaces most commonly involved


    • Ventricular system variably involved, commonly associated with hydrocephalus



      • May involve choroid plexus


  • Ependymal Cyst



    • Nonenhancing thin-walled congenital cyst



    • Follows CSF on all sequences


    • Lateral ventricle atrium most common site


Helpful Clues for Rare Diagnoses

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Lateral Ventricle Mass

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