Third Ventricle Mass, Body/Posterior



Third Ventricle Mass, Body/Posterior


Gregory L. Katzman, MD, MBA



DIFFERENTIAL DIAGNOSIS


Common



  • Pulsatile CSF


  • Dilated Suprapineal Recess


  • Neurocysticercosis


Less Common



  • Germinoma


  • Prominent Massa Intermedia, Chiari 2


  • Choroidal Metastases


  • Choroid Plexus Papilloma


Rare but Important



  • Xanthogranuloma


  • Ependymal Cyst


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • True primary posterior 3rd ventricle masses rare


  • Most represent extension from pineal pathology


Helpful Clues for Common Diagnoses



  • Pulsatile CSF



    • 2° to time-of-flight effects/turbulent flow


    • ↑ With thinner slices, longer TE, imaging perpendicular to flow


    • Evaluate other planes for real vs. artifact


  • Dilated Suprapineal Recess



    • Chronic aqueductal stenosis (any etiology)


    • Third ventricle dilates


    • May deform rostral tectum, mimic tectal glioma


  • Neurocysticercosis



    • Cystic lesion typically slightly hyperintense to CSF


    • ± Discrete eccentric scolex


    • Cisterns > parenchyma > ventricles


Helpful Clues for Less Common Diagnoses



  • Germinoma



    • Usually extension from pineal tumor


    • Strong enhancement, ± CSF seeding


    • Restricted diffusion due to high cellularity


  • Prominent Massa Intermedia, Chiari 2



    • Large massa intermedia typical of Chiari 2


  • Choroidal Metastases



    • T1 hypo T2 hyperintense; avidly enhance


    • Lateral ventricles > 3rd > 4th


  • Choroid Plexus Papilloma



    • Strongly enhancing, lobulated mass


    • Hydrocephalus, ↑ intracranial pressure 2° to increased CSF production


    • Lateral ventricle > > 3rd


Helpful Clues for Rare Diagnoses



  • Xanthogranuloma



    • CT variable


    • MR T1 iso-hyper/T2 hyperintense


    • Lateral > > 3rd ventricle


    • Obstruction infrequent (3rd > lateral)


  • Ependymal Cyst



    • Nonenhancing thin-walled cyst


    • CSF density/intensity


    • Rare in 3rd ventricle






Image Gallery









Axial FLAIR MR shows CSF flow anomaly image manifesting as a hypointense “pseudolesion” of the posterior 3rd ventricle. Examining other sequences & planes confirmed this as flow artifact.

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Third Ventricle Mass, Body/Posterior

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