ABSTRACT. The imaging findings of a case of metastasing meningioma are described. The case illustrates a number of rare and interesting features. The patient presented with haemoptysis 22 years after the initial resection of an intracranial meningioma. CT demonstrated heterogeneous masses with avid peripheral enhancement without central enhancement. Blood supply to the larger lesion was partially from small feeding vessels from the inferior pulmonary vein. These findings correlate with a previously published case in which there was avid uptake of fluoro-18-deoxyglucose peripherally with lesser uptake centrally. The diagnosis of metastasing meningioma was confirmed on percutaneous lung tissue biopsy. . Meningiomas are usually indolent, slow-growing tumours and surgery is curative in the majority of cases [2,3]. We present a rare case of a woman who had resection of an intracranial meningioma performed 22 years previously. The patient presented with haemoptysis and on imaging was found to have bilateral pulmonary lesions; these were confirmed as metastatic meningioma following CT-guided percutaneous biopsy. This report focuses primarily on the imaging features of a meningioma that metastasised to lung. Particular reference is given to CT and combined positron emission tomography and CT (PET/CT) appearances. The role of percutaneous lung biopsy in histological confirmation of the diagnosis is also briefly discussed.
Case reportA 74-year-old woman presented with haemoptysis. She had a history of intracranial meningioma, resected 22 years previously in 1985. The patient had undergone two further resections for intracranial local recurrence in 1988 and 1992 (3 years and 7 years following initial resection, respectively). A chest radiograph revealed two well-circumscribed masses, one at each lung base without a pleural abnormality. CT scan of the thorax was performed and included unenhanced, arterial phase (25 s post-iv contrast administration) and portal venousphase (75 s post-iv contrast administration) imaging (Figure 1). CT demonstrated two well-circumscribed rounded lesions, which were peripherally located in the lungs: a 3.8 cm mass in the right lower lobe and a second 2.7 cm mass in the left lower lobe. The lesions had low-density centres (21 HU) that did not significantly enhance post-iv contrast administration (29 HU in arterial and portal venous phase images). The periphery of the lesions enhanced from 50 HU on the unenhanced images to 111 HU on the arterial phase images and de-enhanced to 83 HU on portal venous-phase images. The periphery of these lesions, therefore, enhanced avidly post-iv contrast administration; the lesions were noted to have prominent feeding vessels in their walls, which were fed by branches of the inferior pulmonary veins. CT scan of the brain (pre and post iv contrast administration) showed no evidence of recurrent or metastatic disease.Full-body combined fluoro-18-deoxyglucose (FDG) PET/CT imaging demonstrated avid FDG uptake within both lung lesions with standard uptake values (SUV)...