Multiple cerebral cavernous hemangiomas masquerading as hemorrhagic brain metastases

Parissa Feizi; Dhairya A Lakhani; Saurabh Kataria; Samiksha Srivastava; Abdul R Tarabishy; Gerard Deib; Shitiz Sriwastava

doi:10.1016/j.radcr.2020.07.069

Multiple cerebral cavernous hemangiomas masquerading as hemorrhagic brain metastases

Radiol Case Rep. 2020 Aug 20;15(10):1973-1977. doi: 10.1016/j.radcr.2020.07.069. eCollection 2020 Oct.

Authors

Parissa Feizi¹, Dhairya A Lakhani^{1

2}, Saurabh Kataria³, Samiksha Srivastava³, Abdul R Tarabishy¹, Gerard Deib¹, Shitiz Sriwastava³

Affiliations

¹ Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV.
² Department of Radiology, West Virginia University, Morgantown, WV.
³ Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV.

Abstract

Intracranial hemorrhagic metastases are a relatively common finding in patients with thyroid carcinoma. Consequently, more unusual vascular lesions may be overlooked in contemplating a differential diagnosis in this patient group. A 50-year-old female with previously treated papillary thyroid carcinoma presented to the emergency department following new onset seizures. Her work up revealed multiple intraparenchymal brain lesions, hyperdense on computed tomography and demonstrating susceptibility effect, T1 shortening and contrast enhancement on magnetic resonance imaging, suggestive of metastases. Subsequent studies revealed lesional architecture consistent with multiple cavernous malformations, made evident by resolution of edema and evolution of blood products. Clinicians should be aware of the possibility of unusual intracranial hemorrhagic lesions in oncology patients which may only become evident on serial imaging evaluation. Cavernous hemangioma has typical MRI characteristic features which includes "mulberry" appearance on T2-weighted and fluid attenuation inversion recovery images with varying internal signal intensity which indicates multiple stages of blood products within the cavernous hamngioma. The lesions commonly have a typical T2-weighted dark hemosiderin rim. Blood sensitive demonstrates prominent surrounding hypointensity representing blooming secondary to internal blood products and/or calcification, if present. Cavernous hemangioma may rarely demonstrate some degree of contrast enhancement. Perfusion imaging may show alteration in capillary permeability involving cavernous malformations which has been previously described in the literature.

Keywords: CT, computed tomography; Cavernous hemangioma; FLAIR, fluid attenuation inversion recovery; GRE, gradient echo sequences; Intracranial hemorrhagic metastasis; MRI, magnetic resonance imaging; Papillary thyroid carcinoma; RAI, radioactive iodine; SWI, susceptibility-weighted imaging.

Publication types

Case Reports

Grants and funding

U54 GM104942/GM/NIGMS NIH HHS/United States