Venous structures can mimic masses in the foramen magnum
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Enhancing masses in the foramen magnum and craniocervical junction (CCJ) can be malignant or benign in etiology and often require serial imaging follow-up and if needed, surgical resection. A new entity termed “benign enhancing foramen magnum lesions” has been described as single lesions which either represent a varix or ganglion.

A 63-year-old male patient with parkinsonism obtained a MRI brain with IV contrast in 2020. The volumetric axial T1 postcontrast sequence demonstrates a 7 mm enhancing lesion in the right spinal canal at the level of C1-C2 which is congruent with the dorsal nerve root and adjacent right internal vertebral venous plexus and therefore is most likely venous in etiology. This structure was unchanged in size compared to an unenhanced CT head and demonstrated an internal Hounsfield of around 25 .

This case demonstrates previously undescribed variations in these venous structures including contacting the PICA and lateral epidural venous plexus, demonstrating segmental dilatations, and transverse orientation and linear shape. Furthermore, these structures can be seen on unenhanced CT head but require MRI with IV contrast for further evaluation. Knowledge of the presence and variability in appearance of these venous structures is important for physicians to avoid mislabeling them as masses or vascular malformations and to avoid potential surgical mishaps.

Source: https://www.sciencedirect.com/science/article/pii/S1930043320301138?dgcid=rss_sd_all
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