10-year-old male with first-time seizure found to have a left temporal lobe mass on CT head performed at outside hospital. There is a heterogeneous T2 hyperintense lesion with T2 hypointense rim in the left temporal lobe, measuring approximately 32 x 23 x 13 mm (AP x TR x CC). There is associated intrinsic T1 shortening and extensive susceptibility artifact. There may be mild, partial enhancement, but some of this is likely attributed to the intrinsic high T1 signal. There is no significant surrounding edema or mass effect. There is suggestion of mild volume loss of the surrounding parenchyma. There is some prominent left sided venous structures including the left basal vein of Rosenthal, which may be related to venous congestion. There is no evidence of acute infarct. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.
1. Heterogeneous T2 hyperintense lesion measuring up to 32 mm in the left temporal lobe with hemosiderin staining peripherally is most favored to represent a large cavernous malformation. There is minimal prominence of the adjacent veins as described above which may be related to venous congestion. Underlying arteriovenous malformation or hypervascular neoplasm with remote hemorrhage are less likely possibilities. Comparison with outside CT would be helpful if made available.2. No surrounding edema or significant mass effect. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.