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Topographically associated cavernous angioma and developmental venous anomaly (DVA), case 1

This 33 year old male presented with sudden onset of severe headache and vomiting.
Emergency CT examination revealed an inhomogeneous mass in the anterior aspect of the 3rd ventricle, as well as dilatation of the lateral ventricles. No subarachnoid hemorrhage was identified. After installation of a ventriculo-peritoneal shunt a complementary MRI was performed and suggested the diagnosis of cavernous angioma associated with an adjacent DVA.

(Cavernous angioma + DVA, 1.5T)
Fig.1 Transverse proton density weighted fast spin-echo images. A bilobed lesion is seen adjacent to the right lateral wall of the 3rd ventricle with partial intraventricular extension. The signal characteristics of the lesion (hyperintense center, surrounded by a hypointense rim) are highly suggestive of a cavernous angioma.
Fig.2 Transverse T2-weighted fast spin-echo images. Same observations as on Fig.1.
Fig.3 Sagittal non-enhanced T1-weighted spin-echo images. The hyperintense center corresponds to methemoglobin, the hypointense rim reflects intracellular hemosiderin.
Fig.4 Sagittal Gadolinium-enhanced T1-weighted spin-echo images. Adjacent to the cavernous angioma, several enhancing irregular vascular structures appear in the basal ganglia.
Fig.5 Coronal Gadolinium-enhanced T1-weighted images. Suggestion of a topographically associated DVA, the caput medusae situated in the contralateral basal ganglia with drainage towards the internal cerebral vein.
N.B. This patient was felt to have a topographically associated cavernous angioma and DVA. However, this patient did not have either MRA or conventional cerebral angiography in his diagnostic imaging work-up. Moreover, he never underwent operation for the cavernous angioma. Hence neither of the lesions was ever confirmed angiographically, surgically or histologically. It demonstrates however, that in many cases a reasonably confident diagnosis of both lesions can be made by conventional MRI without the need for further diagnostic evaluation

 

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Fig. 1

Topographically associated cavernous angioma and developmental venous anomaly (DVA), case 1, Fig. 1
Topographically associated cavernous angioma and developmental venous anomaly (DVA), case 1, Fig. 2
Topographically associated cavernous angioma and developmental venous anomaly (DVA), case 1, Fig. 3
Topographically associated cavernous angioma and developmental venous anomaly (DVA), case 1, Fig. 4
Topographically associated cavernous angioma and developmental venous anomaly (DVA), case 1, Fig. 5