Board Review 3 – Case 1

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows a minimally enhancing mass along the anterior part of the septum pellucidum. This patient also has hydrocephalus which may be contributing to the symptoms.

The diagnosis is: subependymoma

Masses in the ventricles and along the septum pellucidum have a broad differential diagnosis, but in this case subependymoma is the best fit because it is a relatively indolent appearing, minimally enhancing mass.

The other possibilities include:

  • ependymoma – usually has more avid enhancement
  • central neurocytoma – also usually has more enhancement
  • subependymal giant cell tumor (SEGT) – possible, but more likely in a patient with tuberous sclerosis
  • choroid plexus tumor – more commonly enhances avidly
  • hemangioblastoma – often will have flow voids
  • metastatic disease – also more avid enhancement

If you see a minimally enhancing ependymal/subependymal tumor, think about subependymoma.