PMC4093747_01
Case 1 Plain computed tomography (CT) shows a hyperdense mass lesion in the left frontal lobe (a). Fluid-attenuated inversion recovery (FLAIR) reveals the lesion as a mixture of hypo- and hyperintensity mass with extensive brain edema (b). Gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) shows mild enhancements (arrow heads) (c). Follow-up FLAIR imaging performed 1 year after surgery shows improvement of perifocal edema and no recurrence of chronic encapsulated intracerebral hematoma (CEIH) (d)
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F1
Plain computed tomography (CT) showed a faint hyperdense mass in the right frontal lobe [Figure 1a]. Fluid-attenuated inversion recovery (FLAIR) imaging revealed the lesion as a low-intensity mass accompanied by extensive perifocal edema [Figure 1b]. T1-weighted magnetic resonance imaging (MRI) showed faint enhancement [Figure 1c]. The preoperative differential diagnosis included metastatic brain tumor. MRI showed the disappearance of CEIH and cerebral edema, and no recurrence [Figure 1d and e].
Intraoperative view Left frontal craniotomy was performed and a well-defined mass lesion was found located entirely within the brain parenchyma (arrows) (a). The hard mass lesion with yellowish membrane was removed en bloc (arrows) (b)
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F2
The hard mass lesion with yellowish membrane was removed en bloc through a transcortical approach [Figure 2].
Photomicrographs of surgical specimen Hematoxylin and eosin stain shows hemosiderin (arrowheads) and granulation tissues (a). Masson trichrome stein shows collagen fibers within the capsule wall (black arrows) (b). Berlin blue stain shows hemosiderin deposition in the capsule wall (black arrows) (c)
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F3
The mass lesion contained old clots and muddy hematoma, and histological examination confirmed the diagnosis of CEIH [Figure 3].
PMC4093747_02
Case 2 Plain CT shows a hyperdense mass lesion in the left frontal lobe (a). T2-weighted MRI reveals the lesion as an isointense mass with low-intensity rims (b) and gadolinium-enhanced T1-weighted MRI shows ring enhancement (c). Follow-up FLAIR imaging and CT performed 1 year after surgery reveal disappearance of perifocal edema and no recurrence of CEIH (d)
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Plain CT showed a faint hyperdense mass lesion in the left frontal lobe [Figure 4a]. T2-weighted MRI revealed the lesion as an isointense region with high-intensity rims and peripheral edema [Figure 4b], and gadolinium-enhanced T1-weighted MRI showed ring enhancement [Figure 4c]. MRI showed disappearance of the mass lesion and cerebral edema, and there has been no recurrence after 2 years of follow-up [Figure 4d].
PMC4093747_03
Case 3CT shows a faint hyper dense mass lesion in the right frontal lobe (a). FLAIR reveals the lesion as a mixed hypo- and hyperintensity mass with brain edema (b). T2*-weighted gradient echo imaging reveals the lesion as high intensity with low-intensity rims suggestive of hemosiderin deposition (c). Gadolinium-enhanced T1-weighted MRI shows ring enhancement (d). FLAIR imaging 2 weeks after initial MRI reveals that the lateral region of the mass has become hyperintense (arrowhead) (e). Follow-up CT and FLAIR MRI performed 6 months after surgery show no recurrence of CEIH (f,g)
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F5
CT demonstrated a faint hyperdense mass in the right frontal lobe [Figure 5a]. FLAIR revealed the lesion as mixed-intense and hyperintense mass with perifocal edema [Figure 5b]. T2*-weighted gradient echo imaging revealed the lesion as a high-intensity mass with low-intensity rims suggestive of hemosiderin deposition [Figure 5c]. Gadolinium-enhanced T1-weighted MRI showed ring enhancement [Figure 5d]. FLAIR revealed the lesion as mixed-intense and hyperintense mass, with the lateral part of the lesion becoming hyperintense 2 weeks after initial MRI [Figure 5e]. Follow-up MRI showed no recurrence of the lesion at the 1-year follow-up [Figure 5f, g].