A 24 years old male patient with headache and epistaxis

Images

Doctor's Information

Name : morteza
Family : sanei
Affiliation :Radiology department,shoahada tajrish hospital,SBMU
Academic Degree : associate professor of radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : maryam babaie

Case Section

Head & Neck Imaging

Patient's Information

Gender : Male
Age : 24

Clinical Summary

A 24 years old male patient with headache and epistaxis

Imaging Findings

Axial , Coronal and Sagittal CT scan shows a expansive, well–circumscribed mixed lytic-sclerotic bony lesion envolving clivus, encroaching on sellar fossa, posterior nasal cavity, posterior ethmoidal air cells, optic foramina.remodeling posteromedial orbital.

Differential Diagnosis

clival chordoma, giant pituitary adenoma

Final Diagnosis

Intraosseous hemangioma, mixed cavernous and capillary type ( pathology proven)

Discussion (Related Text)

primary intraosseus haemagiomas of the skull base clinically and radiologically can mimic many other common lesions of the skull base (i.e. clival chordoma, giant pituitary adenoma) making their makes their preoperative diagnosis extremely difficult.Primary intraosseus haemagiomas usually expand externally and neurological deficits are unusual, when there is intracranial extension it produces headache, oculo-visual and/or other cranial nerve deficits. Skull base intraosseus haemangiomas are slow-growing, expansile lesions that can involve neighboring structures including cavernous sinus and carotid artery . On conventional radiographs, these lesions appear as an expansile, well-circumscribed area of rarefaction with a sunburst pattern of trabeculations radiating from a common center this can be better seen on CT scan.MRI is the study of choice for better delineation, to establish a radiological diagnosis and to differentiate primary intraosseus haemagiomas from other commoner lesions of the sellar region. Primary intraosseus haemagiomas produce variable signal characteristics on MRI. On MRI primary intraosseus haemagiomas usually appear mottled and heterogeneous with both increased and decreased signal intensities on both T1- and T2-weighted images depending on the quantity of slow moving venous blood and on the ratio of red marrow to converted fatty marrow. Primary intraosseous haemangiomas typically enhance well after gadolinium administration.Angiography of larger hemangiomas typically demonstrates a hypervascular lesion and a delayed blush with feeding arteries and no draining veins. Primary intraosseus haemagiomas do not undergo spontaneous involution and gross total surgical excision is recommended to relieve the mass effect and reverse the neurological compromise, and to obtain a definitive diagnosis.

References

A. AGRAWAL, N. BAISAKHIYA, R. CINCU, A. BHAKE: Primary Intraosseus Haemagioma of The Clivus Mimicking Giant Pituitary Macroadenomoa. J Neurol Sci [Turk] 2009;26:513-517