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Case 25

Meningeal secondary deposits from breast carcinoma

A middle aged woman with loss of bladder control

This woman presented with a history of loss of bladder control. She had previously been treated for breast carcinoma, but had no other past history of note.

Sample images from the sagittal T2 weighted, T1 weighted and T1 gadolinium enhanced sequences are shown.

Findings

On the T2 weighted images there was the suggestion of some nodularity of the lumbar nerve roots, in retrospect. However these are not clearly visible on these images (a small nodule is just visible adjacent to L2). No abnormality was seen on the T1 weighted images. Essentially the pre contrast images were thought to be normal. A small haemangioma is noted in the body of L1.

However following intravenous gadolinium there is enhancement of the nerve roots (compare the two T1 weighted images) due to meningeal deposits from her breast carcinoma.

Diagnosis

Metastatic breast carcinoma with meningeal infiltration and deposits

Discussion

This case demonstrates the usefulness of contrast enhancement when looking for diffuse malignant infiltration. The same effect may be seen in MR of the brain.

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