Discussion

This case showed interval appearance of hemorrhagic enhancing subpial lesions in the watershed regions consistent with embolic metastases that may have already transgressed the vessel wall [2, 4]. The fusiform aneurysms that were seen separate from these lesions showed CAWE on MRVWI that may be suggestive of vessel wall inflammation or infiltration [5], and its presence in apparently normal vascular segments on conventional angiography as seen in our case could possibly predate the formation of myxomatous aneurysms. MRVWI may thus be a useful diagnostic tool for the evaluation of patients after atrial myxoma excision in predicting the future risk of development of the myxoma associated aneurysms. Identification of this inflammatory/infiltrative vessel wall pathology may help in planning treatment strategies for this rare condition.