Differential Diagnosis
- Single most likely diagnosis
- Meningioma: This is the most likely diagnosis due to the lesion's characteristics, including homogeneous enhancement on gadolinium contrast administration and dural extension, which are typical features of meningiomas. Meningiomas are also common in this age group and can appear iso-intense on T1 and hyperintense on T2 sequences.
- Other Likely diagnoses
- Chondrosarcoma: Although less common, chondrosarcomas can exhibit similar imaging characteristics, including dural extension and homogeneous enhancement. However, they tend to have a more heterogeneous appearance and may contain calcifications.
- Cholesterol granuloma: These lesions can appear hyperintense on T2 sequences and may show enhancement, but they are typically found in the petrous apex and do not usually exhibit dural extension.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Cholesteatoma: Although cholesteatomas are less likely to exhibit homogeneous enhancement and dural extension, they can be aggressive and cause significant morbidity if left untreated. It's essential to consider this diagnosis, especially if there are any symptoms suggestive of infection or erosion of surrounding structures.
- Rare diagnoses
- Lipoma: Lipomas are rare in this location and would typically appear hyperintense on T1 sequences due to their fat content, which does not match the provided imaging characteristics. However, it's essential to consider lipomas in the differential diagnosis, especially if there are any atypical features or if other diagnoses are ruled out.