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Slice 6 of 76
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CTMusculoskeletalConfirmedFRCR 2B
Cerebral tuberculosis with dural sinus invasion
Clinical Presentation
Cystic mass midline of occiput. Thought to be a sebaceous cyst. Patient dizzy. No fever.
- 16 cm mass in the central occipital area close to the vertex with a 1.8 cm bony defect.The external component is cystic but the larger intracranial element is composed of solid enhancing soft tissue
- 2This is irregular and extends along the posterior interhemispheric fissure and invades the sagittal sinus.2.7 cm enhancing cystic lesion in the right occipital lobe.Gross oedema of the occipitoparietal regions bilaterally.Comment: Large occipital skull/dural based massThe differential includes haemangioperitocytoma, dural lymphoma, malignant meningioma and far less likely tuberculosis
- 3Immediate recall for contrast studySee combined report above for CT head
- 4MRI BRAIN - with contrast and MRV4 cm midline occipital cystic lesion which communicates through a smooth defect of 9 mm in the occipital bone
- 5This directly communicates with thick irregular enhancing soft tissue surrounding and involving the posterior aspect of the sagittal sinus.Several small sub-centimeter nodules along the course of the sagittal sinus
- 6No flow in the mid and posterior aspects of the sagittal sinus.2.4 cm rim enhancing cystic right occipital lobe lesion with avid internal restriction.Intense, near symmetrical vasogenic oedema in both parieto-occipital regions.No hydrocephalus.Infratentorial brain normal in appearance.Comment:1
- 7Right occipital lobe cerebral abscess2
- 8Dural centered solid-cystic lesions - these appear most likely infectious-inflammatory in nature
- 9Tuberculosis would be the first consideration.3
- 10Sagittal sinus occlusion with resultant cerebral oedema.