T1 pre-gad T1 post-gad with fat sat T2

Diagnosis: Cavernous hemangioma

Cavernous hemangiomas are more typically parenchymal, may be multiple and often have calcifications on CT. Enhancement and signal characteristics are variable and they often contain hemorrhages of variable ages. Acute hemorrhage is atypical. The classic MR description of a cavernous hemangioma is a popcorn- like appearance with a dark rim of hemosiderin on T2. They are not seen on angiography. Histologically, cavernous hemangiomas consist of dilated sinusoids lined by endothelium without normal intervening neural tissue. The typical patient presents in young adulthood with seizures or focal neurologic deficit.

In this case, the diagnosis of intraventricular cavernous hemangioma or thrombosed AVM is suggested by the signal characteristics compatible with hemorrhage of varying chronicity without enhancement. Ependymoma should enhance and usually does not acutely hemorrhage. Pineal mass is not in the differential because the origin of this lesion is in the middle of the third ventricle rather than the pineal gland itself. Intraventricular meningiomas occur however they are usually in the atrium of the third ventricle and intensely enhance. Dermoid is ruled out since there was no change in signal with fat saturation. Related Cases

Pineal cyst ACA aneurysm Bifrontal hemorrhage