IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Pachymeningitis

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Achondroplasia. Now headache and pins and needles in arms. No overseas travel. No seizures.

Patient Data

Age: 40 years
Gender: Male
mri

A region of vividly enhancing extra-axial tissue is seen over the surface of the right parietal lobe with extension across the midline and superior sagittal sinus. There is extension into the sulci with adjacent edema / T2 signal change in the parietal lobe. 

Case Discussion

Patient went on to have a biopsy.

Histology

MICROSCOPIC DESCRIPTION:Paraffin sections show dense infiltration of dura by a mixed cellular infiltrate. This is composed predominantly of lymphocytes lacking atypical features as well as plasma cells and monocyte macrophages. There is proliferation of small caliber vascular channels with swollen lining endothelium. Granulomas are not identified. There is no evidence of haemophagocytosis by monocyte macrophages. No eosinophils are identified. 

Immunohistochemistry shows the lymphocytic infiltrate is a mixture of B and T cells. No CD30+ cells are seen. There is no immunostaining for IgG4 or CD1a and EBER-CISH is negative. The features are of non-specific pacchymeningitis. No evidence of tumor is seen.

FINAL DIAGNOSIS: Non-specific pachymeningitis; no evidence of tumor seen.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.