Learning Radiology xray montage
 
 
 
 
 

Hemangioblastoma



  • Benign neoplasm
  • 80% found in cerebellum
    • Remainder are located in spinal cord > medulla > cerebrum
  • Account for 10% of posterior fossa masses (vestibular schwannomas and metastases rule here.)
  • Most often occurs in ages 30 to 40
    • M > F
  • Relationship to von Hippel-Lindau disease
    • 20% occur in patients with von Hippel-Lindau disease (multiple lesions).
    • 35-60% of von Hippel-Lindau disease patients have hemangioblastomas
    • von Hippel-Lindau disease consists of
      • Retinal, spinal, cerebellar and medullary hemangioblastomas
      • Renal cysts and carcinomas
      • Pancreatic cysts
      • Pheochromocytomas
      • Papillary Cystadenoma of the epididymis
  • Clinical findings
    • Headache
    • Ataxia
    • Nausea
    • Vomiting
    • Vertigo
    • Polycythemia caused by increased erythropoietin found in 40%.
    • Spinal lesions may present with subarachnoid hemorrhage
  • Findings on CT and MRI:
    • Cystic lesion in the cerebellum with an avidly enhancing mural nodule (75%)
    • Purely solid enhancing lesion (10%)
    • Enhancing lesion with multiple cystic areas (15%)

Hemangioblastoma

MRI of brain shows a cystic lesion in the cerebellum with an enhancing nodule (post-Gadolinium)

  • Findings on angiography:
    • Vascular nodule within an avascular mass
    • Serpentine vessels
  • Treated with surgical removal of solid nodule
    • Cystic component is not neoplastic
  • DDx:

o       Similar appearance to Juvenile pilocytic astrocytoma

ยง         But that is typically found in patients 5 to 15 years of age.