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Multiple cerebral cavernous hemangiomas masquerading as hemorrhagic brain metastases
Parissa Feizi1, Dhairya A Lakhani1,2, Saurabh Kataria3
1Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV.
Radiology Case Reports
|September 3, 2020
Summary
Intracranial hemorrhagic metastases are common in thyroid cancer. However, this case highlights that unusual vascular lesions like cavernous malformations can mimic metastases on initial imaging.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- Intracranial hemorrhagic metastases are common in patients with thyroid carcinoma.
- Unusual vascular lesions may be overlooked in the differential diagnosis of brain lesions in oncology patients.
Observation:
- A 50-year-old female with treated papillary thyroid carcinoma presented with new-onset seizures.
- Initial imaging revealed multiple intraparenchymal brain lesions suggestive of metastases.
- Serial imaging demonstrated resolution of edema and evolution of blood products, revealing cavernous malformations.
Findings:
- Cavernous malformations can present as multiple intraparenchymal brain lesions.
- Typical MRI features include a "mulberry" appearance, T2-weighted dark hemosiderin rim, and blooming on susceptibility-weighted imaging.
- Contrast enhancement and perfusion changes may occur but are less common.
Implications:
- Clinicians should consider cavernous malformations in the differential diagnosis of intracranial hemorrhagic lesions in oncology patients.
- Serial imaging is crucial for identifying unusual lesions that may mimic metastases.
- Awareness of these atypical presentations can prevent misdiagnosis and guide appropriate management.
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