Journal of the Louisiana State Medical Society
Figure 2: MR images: (Top row, left to right) axial T1W, axial DWI, coronal T2W. (Bottom row, left to right) images in axial, coronal, and sagittal, respectively, demonstrating an enhanced soft tissue mass in the left parietal region.
diagnosis.
Imaging (MR) revealed a 4.6 x 4.1 cm mass (Figure 2), sug- gesting a lesion arising from the calvarium or an extra-axial mass, such as a meningioma. A cerebral angiogramdemon- strated the mass to be supplied primarily by the branches of the left middle meningeal and superficial temporal arteries (Figure 3). The patient was lost to follow-up and presented to the emergency room six months later with signs and symptoms of meningitis. At that time, CT showed interval enlargement of a left parietal extra-axial hyperdensemass nowmeasuring 8.0 x 6.5 cm associated with bone destruction, calcifications, and areas suggestive of necrosis. MR demonstrated the mass to be arising from the calvarium, unchanged in signal characteristics from the previous imaging studies but with additional smaller lesions throughout the calvarium, further
CASE PRESENTATION A 63-year-old African-American female, with an ex- tensive past medical history that included schizophrenia, substance abuse, diabetes, hypertension, and Hepatitis C presented to the surgery clinic with an enlarging mass on the left posterior scalp parietal region. The mass was reportedly tender to palpation; cough or sneezing also precipitated local pain. Initial imaging with Computed Tomography (CT) re- vealed a large soft tissue mass appearing to arise from the calvarium with minimal moderate extrinsic mass effect on the adjacent brain, (Figure 1) while Magnetic Resonance
150 J La State Med Soc VOL 166 July/August 2014
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