Demographics:
6 years old, Female
Indication:
Headache
Findings
CT
- Masslike area of hypoattenuation involving the dorsal pons and middle cerebellar peduncles with mass effect on the fourth ventricle
- Mucosal thickening and fluid in the bilateral sphenoid sinuses and posterior ethmoid air cells
MRI
- Masslike area of T2/FLAIR signal hyperintensity involving the pons, midbrain including the cerebral peduncles, left eccentric medulla, and left greater than right middle cerebellar peduncles
- Area of relative restricted diffusion in the ventral aspect of the pons
- The mass bulges into the prepontine cistern and at least partially encases the basilar artery
- Associated mass effect on the fourth ventricle without overt hydrocephalus
- No corresponding enhancement
Annotated Images & Illustrations
Homogeneous FLAIR hyperintense mass involving the entire pons and extending into the midbrain and medulla, which is a classic imaging appearance for a diffuse midline glioma.
Area of mild restricted diffusion in the ventral pons, which demonstrated elevated cerebral blood volume on perfusion analysis (red arrows).
Diagnosis
Diffuse midline glioma
Key Imaging Features
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Differential Diagnosis
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Discussion
Pearls
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