Dural lymphoma mimicking subdural haematoma on computerized tomography

Abstract

A 69-year-old man was admitted for investigation of a 2-month history of left-sided weakness and headache with dizziness. There was no history of trauma. Initial cranial computerized tomography (CT) showed an extra-axial crescentshaped hyperdense lesion in the right frontoparietal region (top left). CT performed 1 month later showed no involution of the collection and persistence of its hyperdensity. Magnetic resonance imaging (MRI) revealed an extra-axial pachymeningeal lesion that was hypointense on T2 weighting (top right), with intense pachymeningeal and leptomeningeal enhancement on a T1-weighted image after contrast administration (bottom left); hypointensity on an apparent diffusion coefficient map (bottom right) confirmed restricted diffusion. These findings suggested meningeal lymphoma. Serum protein electrophoresis showed a monoclonal peak of immunoglobulin M (4Á26 g/l) and bone marrow biopsy showed extensive interstitial infiltration by small lymphoplasmacytic cells. A diagnosis of lymphoplasmacytic lymphoma was made.The patient received six cycles of rituximab plus cyclophosphamide, vincristine and prednisone (R-CVP), and achieved regression of the meningeal lesions.The typical radiological picture of an acute subdural haematoma on CT (hyperdense extra-axial collection) in a patient without a history of trauma and the persistence of this abnormality on follow up CTs suggests an alternative diagnosis and the need for further radiological investigation with MRI.

De novo primary malignant lymphoma of the dura following recurrent episodes of subdural abscess presenting as chronic subdural hematoma: illustrative case

“…In the literature, multiple researchers have reported a total of 14 cases of PCNSL that were initially diagnosed as subdural hemorrhage; the characteristics of these cases are presented in Table 1 . 5 – 17 Of these 14 cases, 10 were MALT lymphoma, 2 were DLBCL, 1 was Burkitt lymphoma, and 1 was lymphoplasmacytic lymphoma. Primary dural DLBCL, as in the present case, is rare (2 of 14 cases), and there have been no reports of cases preceded by an intracranial infection.…”

Dural lymphoma misdiagnosed as subdural hematoma following head trauma after an episode of syncope

“…Most patients will receive neuroradiologic imaging shortly after presentation given their neurologic symptomatology. CT of the brain will commonly reveal a single or multifocal irregularly- or crescent-shaped, extra-axial, vividly enhancing, high-density mass compared to the brain parenchyma [5 , 6 , 11 , 12] . The hyperdensity is often attributed to the highly cellular nature of the lesions [12] .…”

“…The hyperdensity is often attributed to the highly cellular nature of the lesions [12] . There is often an associated hypodense area adjacent to the lymphoma which represents vasogenic edema [5 , 6 , 11 , 12] .…”

Subdural anaplastic large-cell lymphoma presenting as a subacute epidural hematoma on imaging: A case report

“…[8] The second is the type of lymphoma. At present, there are mainly the following types reported: lymphoplasmacytic lymphoma, [9] marginal zone lymphoma, [10][11][12][13] diffuse B-cell lymphoma, [14] and Burkitt lymphoma. [15] However, large-cell lymphoma (T-cell and ALK are positive) is rare.…”