Atypical fungal granuloma of the sphenoid wing

A 29-year-old immunocompetent patient presented with a 3-month history of headache and vomiting. Computed tomography (CT) and conventional magnetic resonance imaging (MRI) revealed a mass lesion in the right sphenoid wing. The conventional imaging findings were typical of meningioma. However, diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI) and perfusion-weighted imaging (PWI) all revealed details that were unusual for a meningioma. DWI showed diffusion blackout, perfusion was not raised in PWI, and susceptibility effects were noted in SWI. Based on these findings, the possibility of granuloma was kept as the differential diagnosis. Histopathological examination of the lesion was suggestive of fungal granuloma. This case report highlights the importance of advanced neuroimaging techniques in differentiating meningioma and granuloma.