Lymphoma of the Skull Base

Bizarre Radiography

Fig. 13.20a Review of this head CT in bone windows shows a bizarre calcification below the orbital roof. This is suggestive of a meningioma because these tumors tend to calcify in such a fashion. b Angiography reveals the typical spoke-wheel-type vascular pattern of a meningioma.

Fig. 13.21 This patient complained of an acute decrease of visual acuity on the left. The axial CT section displays the tumor, which extends from the sphenoid sinus into the left orbit and (on other slices) into the optic canal.

Fig. 13.20a Review of this head CT in bone windows shows a bizarre calcification below the orbital roof. This is suggestive of a meningioma because these tumors tend to calcify in such a fashion. b Angiography reveals the typical spoke-wheel-type vascular pattern of a meningioma.

tation of the large-caliber fistula (Fig. 13.19b), detachable balloons can be introduced through a catheter (Fig. 13.19c), filled in situ, and left behind, occluding the fistula.

Meningioma: This benign tumor originates from the meninges and is often found adjacent to the sphenoid bone or the orbital roof. It frequently calcifies (Fig. 13.20a) and enhances strongly after contrast administration in a typical

Fig. 13.21 This patient complained of an acute decrease of visual acuity on the left. The axial CT section displays the tumor, which extends from the sphenoid sinus into the left orbit and (on other slices) into the optic canal.

spoke-wheel fashion (Fig. 13.20b). If surgical removal is contemplated, a preoperative embolization of the richly vascularized tumor by the interventional radiologist is often requested—this time of course not with balloons but with coils or small particles that get caught in the capillaries of the tumor.

Metastases/lymphoma: Metastatic disease and lymphoma must always be considered in the differential diagnosis (Fig. 13.21). They often display infiltrative and destructive growth. In Mrs. Hotblood's case, breast carcinoma would be the most likely primary tumor.

Osteopetrosis: Osseous expansion of the orbit and the sphenoid bone may also cause a protrusion of the eye bulb. This is seen with osteopetrosis (or "marble bone disease" [Fig. 13.22; see also Fig. 8.30c, p. 137)] and Camurati-Engelmann disease (see Fig. 8.30d, p. 137), where the bones become denser and enlarge over time. Both diseases are normally diagnosed during childhood. The cranial foramina become progressively narrowed, often resulting in cranial nerve palsy. Involvement of the optic nerve is particularly precarious and is not uncommon.

0 0

Post a comment