Meningeal Metastases Presenting as Extra-Axial Hematoma: A Diagnostic Pitfall
Abdallah SAID ABDALLAH *
Department of Radiology, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
Mohamed FADIL
Department of Radiology, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
Mehdi SALMANE
Department of Radiology, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
Fatima Zahrae LAAMRANI
Department of Radiology, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
Youssef OMOR
Department of Radiology, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
Rachida LATIB
Department of Radiology, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
Sanae AMALIK
Department of Radiology, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Aims: To illustrate a significant diagnostic pitfall where meningeal metastases mimic benign extra-axial hematomas, and to highlight the crucial role of contrast-enhanced magnetic resonance imaging (MRI) in achieving the correct diagnosis.
Presentation of Case: We report two cases. The first is a 44-year-old female with breast carcinoma whose dural metastases presented on computed tomography (CT) as an enhancing dural-based mass. The second is a 38-year-old male with colorectal cancer whose dural metastasis appeared on CT as a collection suggestive of a subacute hematoma. In both cases, MRI was crucial in rectifying the diagnosis by revealing features of a hypercellular neoplasm. Both patients had a poor outcome, with rapid clinical deterioration despite intervention.
Discussion: The radiological presentation of meningeal metastases can be deceptive. Key MRI findings that argue for a neoplastic process include marked diffusion restriction and nodular dural enhancement.
Conclusion: The possibility of meningeal metastases should be considered in the differential diagnosis of any new extra-axial collection in patients with a known history of malignancy. Contrast-enhanced MRI is indispensable to differentiate these lesions and guide appropriate management.
Keywords: Meningeal metastases, dural metastases, extra-axial hematoma, diagnostic pitfall, breast cancer, magnetic resonance imaging (MRI)