Capillary telangiectasia of the pons

Findings

There is an irregular FLAIR hyperintense focus located along the left anterior aspect of the pons, demonstrating mild lacy contrast enhancement. There is no associated mass effect or restricted diffusion.

Differential diagnosis:
- Developmental venous anomaly
- Cavernous malformation
- Neoplasm
- Inflammation
- Demyelination
- Capillary telangiectasia


Diagnosis: Capillary telangiectasia of the pons


Key points

Capillary telangiectasia
- Represents clusters of dilated capillaries within normal brain
- Usually an incidental finding at imaging
- Represents 15 to 20 percent of brain vascular malformations
- Increased risk for development after brain radiation
- Associated with other vascular malformation, such as cavernous malformation or venous angioma
- Associated with hereditary hemorrhagic telangiectasia

Clinical:
- Usually an incidental finding
- Rarely associated with headache or vertigo
- Found at any age
- No treatment necessary


Imaging

Characteristically found in the pons, but may also be seen in the midbrain, medulla, and elsewhere
Usually small, average 3 cam in diameter
Poorly defined, without mass effect, edema, or restricted diffusion

CT: Usually normal

MRI:
- T1 weighted sequence = usually normal
- T2 weighted sequence = half are normal, half show fine hyperintensity
- Gradient echo = hypointense
- FLAIR = usually normal, but may show foci of hyperintensity
- Diffusion weighted image = usually normal
- Post contrast images = faint lacy or speckled enhancement
- May have associated linear vessels or draining veins if associated with venous angioma

Angiography: Usually occult