A Comprehensive Radiology Search Engine

This program allows to search radiology contents, specifically mentioned radiology journals (even all medical journals), radiology cases and teaching files, even single radiological images, radiology news, books, societies, vendors and products. A search for CMEopportunities is also offered. Access to almost all radiology journals and their websites/contents is also available.Most recent news and publications are also offered.

URL-www.radiologysearch.net

Lymphoepithelial cysts in the setting of known HIV

Additional clinical history: Patient has recently tested HIV positive


Findings

Cystic replacement of the parotid glands without evidence of solid enhancing component or periglandular inflammation. Borderline enlarged Level 2 cervical lymph nodes.

Differential diagnosis:
- Treated lymphoma
- Infection / abscess including tuberculosis and atypical mycobacterium
- Brachial cleft cyst
- Abcess
- Warthin gland tumor
- Sjogren's syndrome
- Lymphoepithelial cysts


Diagnosis: Lymphoepithelial cysts in the setting of known HIV


Key points

Development of parotid gland lymphoepithelial cysts occurs early in HIV disease, often with coexistent generalized cervical lymphadenopathy. Because of this, HIV testing should be performed if a patient presents with lymphoepithelial cysts, which occur exclusively in the parotid glands. The cysts are painless and slow growing, with predominantly bilateral involvement. Lesions are usually multicystic with superficial involvement.

During embryonic development, lymph tissue is included in the parotid capsule. This lymphoid tissue is then vulnerable to the HIV virus. Patients with parotid cysts and cervical lymphadenopathy usually have CD4 levels below 500/ml. Pathogenesis of HIV related lymphoproliferative changes of the parotid remains unclear, but is likely related to an exaggerated immunological response to infection.


Radiology

CT/US/MRI: Bilateral superficial parotid cysts with possible associated adenopathy and lymphoid hyperplasia.

Early Morning in Calbayog

This image is now displayed and framed in the town City Hall of Calbayog City, Samar.

Harbor Scenes

Early Morning, Port of Matnog, Sorsogon

Late Afternoon at the Calbayog Harbor

On a clear day in the Port of Allen, Northern Samar

MV Melvin Jules, docked in Allen, Northern Samar

Pituitary apoplexy

Findings

Figure 1 and Figure 2: Non contrast CT head shows enlarged sella with a hyperdensity within it (Figure 1) with secondary thinning of bone (Figure 2).
Figure 3 and Figure 4: Coronal T1 and T2-weighted images show mass of mixed signal with isointense signal at inferior aspect and hyperintense signal at superior part, located in sellar region with suprasellar extension. Internal carotid artery on both sides show normal flow void signal.
Figure 5 and Figure 6: Sagittal T1-weighted image demonstrates the fluid level. Pituitary stalk is normal (Figure 5).


Diagnosis: Pituitary apoplexy


Pituitary apoplexy is defined as a clinical syndrome that may include headache, visual deficits, ophthalmoplegia, or altered mental status. It may occur either due to rapid expansion of an infarcted/hemorrhagic pituitary adenoma. Clinical risk factors are trauma, increased intracranial pressure, anticoagulation, bromocriptine therapy, diabetic ketoacidosis, radiation therapy, and open heart surgery. Apoplexy in pituitary adenomas may vary from 2% to 7%. Nearly 50% of apoplectic events seem to occur in patients who were not known to harbor pituitary lesion previously.

Noncontrast CT may show sellar/suprasellar mass with patchy hyperdensities. MR imaging findings may vary depending upon age of hemorrhage. Early/late subacute hemorrhage may show increased signal as seen in our case. Acute compression of the hypothalamus and/or optic chiasm may cause increase signal on T2 along the optic tracts. Presence of restricted diffusion within an adenoma may suggest an early sign of apoplexy in the form of acute hemorrhage or associated infarction.

Early diagnosis and treatment is necessary to prevent significant morbidity and mortality.

Radiology MCQs from AIIMS & AIPG-2007

1. In a case of multiple myeloma, bone scan will show
a. hot nodules b. cold nodules
c. diffuse increased uptake d. diffuse decreased uptake


2. Patient who had an Road traffic accident presents with presents with loss of consciousness CT shows multiple spotty hemorrhages and full basal cisterns-
a. Brain contusion b. Diffuse axonal injury
c. Subdural Hematoma d. Multiple infarcts


3. Tumour showing dural enhancement with a tail is:
a. Medulloblastoma b. Meningioma
c. Glioma d. Acoustic neuroma

4. A 25-yrs-old female presented with lower limb weakness, spasticity, urinary hesitancy, mid-dorsal intradural enhancing mass seen in MRI. What is the diagnosis?
Intradural lipoma b. Meningioma
c. Dermoid cyst d. Neuroepithelial cyst


5. A neonate presents with congestive heart failure, on examination enlarging fontanellae, bruit on auscultation, on USG shows midline hypoechoeic lesion, most likely diagnosis
A. Malformation of vein of galen B.Aqueduct stenosis
C. Arachnoid cyst D. Medulloblastoma.

6. Best investigation for temporal bone fracture is-
A) CT B) MRI C) X-RAY D) Ultrasound



Answers-
Answer-1) (b)
The bone scan is usually normal in multiple myeloma because lytic lesions do not take up isotope.

Answer-2)
Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients. DAI is the most significant cause of morbidity in patients with traumatic brain injuries, which most commonly are the result of high-speed motor vehicle accidents. Typically, the process is diffuse and bilateral, involving the lobar white matter at the gray-white matter interface. The corpus callosum frequently is involved, as is the dorsolateral rostral brainstem. The most commonly involved area is the frontal and temporal white matter, followed by the posterior body and splenium of the corpus callosum, the caudate nuclei, thalamus, tegmentum, and internal capsule.

Answer-3)
Meningiomas are usually dural-based tumors that are isoattenuating to slightly hyperattenuating. They enhance homogeneously and intensely after the injection of iodinated contrast material. Perilesional edema may be extensive. Hyperostosis and intratumoral calcifications may be present. The tumor compresses the brain without invading it. An enhancing tail involving the dura may be apparent on MRI.

Answer-4)
Meningiomas are the second most common tumor in the intradural extramedullary location, second only to tumors of the nerve sheath. Meningiomas account for approximately 25% of all spinal tumors.MRI demonstrates the intradural extramedullary location of meningiomas. Lesions are usually isointense to spinal cord on both T1-weighted and T2-weighted images. Lesions are sometimes hypointense on T1-weighted images and hyperintense on T2-weighted images.

Answer-5) A Vein of galen malformation

Answer-6) A
for bony temporal bone – CT for inner ear- MRI for facial nerve- MRI

Questions by DAMS The Top most MD/MS entrance coaching academy
DAMS
Delhi Academy Of Medical Sciences

A Manileno in Calbayog Village

It was a tiring getaway, but it was well worth it. It's been two weeks since I was back in Cubao, but the fascinating experience of travel, sun, sand, and fun, still lingers in my mind and soul.

I prefer road trips than airplane trips. Road trips are cheap, exciting, and gets you closer to the sceneries and people; it also offers great opportunites for photography.

Airplane rides, on the other hand, are costly, short, and offers only photography from the sky. And what if the day was cloudy? or the fellow sitting next to you abhors photography?

I always adhere to the maxim that the joy of travel lies not in getting fast to your destination, but the joyride of getting there.

I traveled to the southern places in the Philippines, particularly the Samar and Leyte islands. But Samar may not be in the itinerary of the easychair traveller. Maybe it is because it is out of the way of the more famous tourist destinations like Bohol, Cebu, Palawan, or Panay, where throngs of tourists go all year round. Yet, this in itself is a blessing in disguise to the people of Samar. By less contact with westerners, they retain more of their culture, their simplicity, and their complacency.

Whenever I travel, I remember to bring a few essential things: a boxful of first-aid kit with the usual medicines Bonamine (for bus lag), and Diatabs (for diarrhea, because you'd never ever want bus rides with LBM).

I also only drink bottled distilled water when travelling. I never drink tap water especially on the food stops where passengers dine.

I also remember to bring along my OFF lotion, to protect me from the mosquitoes. I noticed that in the provinces, mosquitoes are more numerous, larger, and more aggressive (though may not be deadlier), than their Manila cousins.

I always kill mosquitoes whenever they happen to pass between the palms of my hands. I will be in this muderous rampage every night I sleep in my in-laws house in Calbayog.

I have decided to stay for a few days in my in-laws house in a deep village in Calbayog City. Unlike in the past when I stayed in hotels, I decided that now, it was time to spend time with my wife's family.

I wanted to feel what it would be like to live among my in-laws and perhaps understand or absorb a few of their cultures. After all, I'm married to a Waray, so I better understand fully their traits and culture.

Also, I felt that with my limited funds, I could save a lot by not having to pay accomodations. The money saved could be used to buy provisions for our daily meals.

As a city fellow, I must adjust accordingly to what my hosts will offer to me, otherwise, I might suffer culture shock. However, I never felt being a stranger. I was welcomed warmly. I felt that my wife's family and relatives were very polite and hospitable, making every effort to make me feel at home.

My in-laws live in a nipa house which is still common in the area. Wide and spacious, it is a two-story house made of unhewn wood, bamboo, and nipa grass. During the day, there was no electricity, but the abundance of trees sorrounding it made it cool and relaxing.

During evenings, electricity was restored and the whole family will watch news on TV. The family dinner followed afterwards, with some fantastic adobo cooked by my mother-in-law.

I also got to know better my father-in-law. A true blooded Waray, he never had been to Manila, and had lived all his life in Calbayog. He marvelled at my photography equipments, at how heavy and expesive they were. I noticed that he didn't know what a digital camera was like. I demonstrated to him my Nikon D80, how it works, and how it didn't need films. When I took his picture, he was amused to see himsledf in the LCD monitor.

We also talked about the things that a son-in-law and a father-in-law usually talked about: how to prevent our wives from staging a coup de etat, and gain full control of running the house. It was something that a Waray man must never let happen...

My father-in-law liked to sing videoke, and he would slowly torture me by singing endless songs by April Boy Regino and Renz Verano. While singing, we would drink Tuba, a local sap wine.
Actually, I rarely drink liqour. For me, they all tasted like bitter medicines, like Tanduay or Ginebra. But Tuba was different, it tasted a little sweet to the tounge, smelled like strong vinegar, smooth, and easy on the throat.

For the Warays, the Tuba is the standard liqour. They drink it regularly like a Pepsi or Coke. I was amused how my father-in-law would gulp straight one full glass during his turn. I was a man also, so I imitated him and drank the same amount. But I must have underestimated the power of the Tuba. After a few glasses, I got drunk, and fell asleep. My father-in-law, however, continued on his singing and drinking galore.

Getting to know one's in-laws in their own territory may be one of the most culturally shocking events one can experience in life. You meet several uncles, aunts, cousins, lolos, and lolas. Although they are nice and hospitable, meeting them for the first time can be both intimidating and fascinating.

I have made a conclusion that when you marry a Waray, you marry her whole family, for the Warays are some of the most closely-tied families you could ever meet. Yet, as a Manileno, I was treated well, and everyone's helpful.

After several days, when it was time for me to leave, everyone came to see me to give me several gifts bid, a few chickens, a boxful of suman, a pitcher of Tuba (hehehe), and other small souvenir items. My grandfather-in-law, 92 years old, gave me a latigo of Manta Ray which he had kept for several years. He said it is an effective weapon against the aswang in Maynila. Although I thought it was very thoughful of him, personally, I would have preferred a weapon against the buwaya in Maynila.

While on the bus headed to Tacloban, I thought of the wonderful and fascinating experiences I had with my wife's family. I thought I'm blessed to have them as my family, and maybe who knows, I may come back frequently, and maybe build a house there myself in the future.

HIV vacuolar myelopathy

Findings

Figure 1 and Figure 2: Sagittal T1 and T2-weighted images of the cervical spine demonstrate minimal hypointensity on T1 with increased signal on T2 extending from C2 though approximately C5. Note the hypointensity in the vertebral bodies on both T1 and T2, a characteristic of HIV disease.
Figure 3: The axial T2 image demonstrates the abnormal signal to be symmetric within the posterior columns of the cord.

Differential diagnosis:
- HIV vacuolar myelopathy
- Subacute combined degeneration (Vitamin B-12 defeciency)
- Syphyllis (tabes dorsalis)
- Viral and post viral illness


Diagnosis: HIV vacuolar myelopathy


Vacuolar myelopathy is the common chronic myelopathy associated with HIV infection, occurring during the later stages of AIDS when lymphocyte counts are extremely low. There are usually other manifestations of AIDS at the time of diagnosis. Patients generally present with insidious progression of weakness and sensory loss with progressive spastic paraparesis in contradistinction to AIDS related CMV myelopathy. With the introduction and widespread use of HAART, vacuolar myelopathy is not as common as it once was occurring in only 10% of AIDS patients.

The histopathological findings include vacuoles and lipid-laden macrophages within the spinal cord. A hypothesis for the disease occurrence is infiltration by HIV infected mononuclear cells which secrete neurotoxic factors.

The most common imaging findings on MRI are atrophy of the cord and abnormal signal on T2 weighted sequences particularly in the posterior columns. This signal abnormality generally occurs over multiple vertebral body lengths.

The clinical and MRI findings are similar to subacute combined degeneration (myelopathy associated with Vitamin B-12 deficiency). This necessitates correlation with laboratory tests. Serum vitamin B-12 along with homocysteine and methylmalonic acid levels should be obtained. Of course in an AIDS patient, CD4 count should be obtained along with the above tests. Other causes of the imaging findings could include viral illnesses and therefore if the diagnosis is not clear, CSF analysis should be performed to identify CMV, varicella, HSV, HTLV-1 or HTLV-2. In HIV associated vacuolar myelopathy CSF and B-12 levels are most often normal.

About the Author of Gray's Anatomy

Did you know that-

"We always pictured Gray as an old man with white hair and glasses, you know, that professor type. So I was shocked to find out that he was only 31 when he wrote Gray’s Anatomy. He did so much as a young man, imagine what he could have accomplished had he lived a full life. He is truly inspirational...."

Full article here-

Street anatomy

Radiology Grand Rounds X are up

Radiology Grand Rounds-X are up at MidEssexRay a site by Dr Peng Hui Lee Chelmsford, Essex, GB,Clinical Director of Radiology, Mid Essex Hospitals NHS Trust. Check out this edition has many new contributors also.

Scenes from A Samar-Leyte Journey

My journey to Samar-Leyte islands started in Cubao Bus terminal where I rode in an air-conditioned bus. I still refuse to ride by airplane as I prefer to travel by land and get to experience the joy of traveling with the local folks. Never mind the length of road-trip nor the utter exhaustion that it entails. For me land travel is still the best!

Bus terminal in Pasay as the passengers ready for the trip to Tacloban

A HighWay scenery in Calamba, Laguna Province. That
mountain in the background is Mount Makiling.

The beautiful Lamon Bay, in Quezon province. I'm sure I will not see
this beautiful view if I'm on an airplane 20,000 feet above.

Maharlika Hi-way along the way to Catbalogan, Samar.

One of the restrooms to be found during stop-overs of buses going south.

The ferry leaving the harbor at Matnog, Sorsogon

Passengers boarding the ferry to Allen, Northern Samar

The Coin Divers of Allen, Northern Samar. The kids wait for the ferry
passengers to throw coins into the sea and they will race for it to get it.

Early morning in Calbayog City, Samar

Seafoods are cheap and bountiful in Tacloban, Leyte

Bagacay Beach, Calbayog City, Samar

The famous Malajog Beach, Samar

Trike drivers, Calbayog City

Rizal Monument, Calbayog City plaza

On the way to Catbalogan, Samar

Calbayog City at night

A beautiful nipa house called locally as Bahay Kubo.
It is spacious and cool inside.

A native sari-sari store in Allen, Samar

The beautiful Malajog Beach.

The moon shines brightly over Tacloban Inn,
Tacloban, Leyte. This is where I stayed in Tacloban City.

Venous sinus thrombosis

Findings

CT head shows hyperdensity in the proximal basal veins of Rosenthal, straight sinus, and superior sagittal sinus. There is some asymmetric effacement of the perimesencephalic cistern, suggesting edema, but no significant change in adjacent parenchymal attenuation. MRI on precontrast axial TW images shows abnormal signal in the straight sinus and superior sagittal sinus. Post-contrast axial T1 weighted images show filling defects in these sinuses.


Diagnosis: Venous sinus thrombosis


Key points

Thrombosis of the cerebral venous sinuses is a difficult diagnosis to make in that presenting symptoms are quite non-specific. Venous sinus thrombosis is now thought to be much more common than before because of improved imaging techniques but is still less common than acute arterial occlusion. Venous occlusion leads to regional ischemia and infarct, most often hemorrhagic and located in the white matter or gray-white junction. Thrombosis of the deep cerebral veins may lead to bilateral thalamic hemorrhagic infarcts. The superior sagittal sinus is most commonly affected, followed by the transverse sinuses, sigmoid sinuses, and cavernous sinuses. The diagnosis should be suspected in patients with appropriate neurologic complaints and pre-disposing conditions such as hyper-coagulable states, adjacent infections (e.g. mastoiditis) or tumors, dehydration, trauma, pregnancy/post-puerpium, or oral contraceptive use. Approximately 25% of patients, however, have no identifiable pre-disposition. Presenting complaints are quite variable and may include headache, nausea, vomiting, seizures, and neurologic deficits. Mortality ranges from 10-80% and is presently more likely at the lower end of this range. Neonates, the elderly, and debilitated patients are most at risk. Systemic anti-coagulation is the standard treatment, with directed endovascular microcatheter infusion reserved for patients who progress despite adequate systemic anti-coagulation.


Radiology

MR with MR venography is the imaging modality of choice for diagnosing this condition. Ideally, on pre-contrast images, there should be loss of the normal flow void in the affected sinuses on T1 and T2 weighted images. This can vary depending on the age of the thrombus, however. Post-contrast images will show a filling defect in the affected sinuses. Flow sensitive imaging (2 D time of flight or phase contrast) is best for determining if thrombosis is indeed present. Hemorrhagic infarcts are best evaluated with gradient echo imaging sequences. Diffusion weighted images are also useful.

CT is also of use in the diagnosis of venous sinus thrombosis (as in this case). Pre-contrast CT will show hyperdensity in the affected sinuses. A classic finding is the "delta sign" in superior sagittal sinus thrombosis where a triangular hyperdensity is seen in the sinus. A "reverse delta sign" can be seen on post-contrast CT representing enhancing dura around thrombus in the sinus. Signs of infarction are classically in non-arterial distributions and can be bilateral and hemorrhagic.

Long waits for Medical imaging

Waits for scan results 'too long'
Detailed report in BBC HEALTH NEWS

"Waits for tests have come downWaits for the results of X-rays and other scans in England are often too long, a report finds. But two out of three doctors and nurses said they often did not get results when needed, and a half said the delays affected patient decisions daily."


Average wait for a non-urgent CT scan:
Seven weeks in 2001
Just over five weeks in 2005

Average wait for an MRI scan:
21 weeks in 2001
14 weeks in 2005

Seems like Teleradiology Providers is on th right track...

Submissions requested for the next Radiology Grand Rounds

Next Radiology Grand Rounds will be hosted on last sunday of this month 25-3-07 at MidEssexRay by Dr Peng Hui Lee, so hurry send all your Radiology Related submissions to me at sumerdoc@yahoo.com or to Dr Peng at pengrad@gmail.com If you are not familiar with the concept of the Radiology Grand Rounds check out the archive and concept here-
Radiology Grand Rounds

Carbon monoxide poisoning

Additional clnical history: Patient sleeps in close proximity to an old furnace.


Findings

Focal bright T2 signal in the globus pallidus bilaterally.

Differential diagnosis: The focal bright T2 signal in the globus pallidus is somewhat specific for CO.

Other causes of bright T2 signal in basal ganglia/thalamus include:
- Wilson disease
- Small vessel ischemic disease (SVID)
- Creutzfeldt-Jacob disease
- Leigh disease
- Japanese encephalitis


Diagnosis: Carbon monoxide poisoning


Key points

Changes are typically seen in globus pallidus, but can occur in cerebral white matter (second most common), putamen, caudate, thalamus.

Radiology:
- Hypodense on CT
- T1W- can be normal, hypo- or hyperintense (edema or hemorrhage)
- T2W - hyperintense
- Diffusion WI - restricted diffusion

Pathologically one sees necrosis in globus pallidus with demyelination of periventricular white matter.
Presents with nonspecific symptoms of variable severity: Nausea / vomiting, headache, confusion, cognitive impairment, seizures, coma, death.
Clinically may have persistent sequelae or resolution of symptoms depending on severity and duration of exposure.
Most common cause of U.S. accidental poisoning.
Can confirm diagnosis with carboxyhemoglobin level.
Treatment: Hyperbaric O2 for acute cases.

ECR-2007

Diagnostic Imaging is offering a webcast of European Congress of Radiology, with many interesting articles. Here is the link-

ECR-2007 Diagnostic Imaging-Webcast

A case Lingual Thyroid

The radfiles blog this week has a very typical CT images of a case of lingual thyroid. A typical spotter for radiology residents.

Here is the case- Lingual Thyroid

CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoenceopalopathy)

Findings

MRI of the brain with diffusion weighted image (Figure 5), ADC map (Figure 6) and multiple FLAIR images (Figures 1, 2, 3 and 4) show marked abnormal T2 signal hyperintensity in the subcortical and deep white matter of the temporal (Figure 4) and frontal lobes (Figure 1 and Figure 2). None of the areas correlate with restricted diffusion (Figure 5 and Figure 6) or acute infarction. In Figure 3, signal hyperintensity involves the external capsules, basal ganglia and thalami bilaterally. Notably absent is abnormal decreased signal in the corpus callosum on the T1 Sagittal and none of the signal hyperintensity in the periventricular white matter is oriented perpendicularly to the lateral ventricles.

Differential diagnosis:
- CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoenceopalopathy)
- Sporadic subcortical ateriosclerotic encephalopathy (sSAE) – This is similar to CADASIL. CADASIL typically has bilateral anterior temporal and superior frontal lobe involvement which is not as commonly seen in sSAE.
- Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) – As opposed to CADASIL, areas of signal intensity associated with MELAS will frequently disappear with clinical improvement. Onset of clinical symptoms occur as early as 15 years of age and include seizures and acute stroke like symptoms.
- Hypercoagulable states (Antiphospholipid syndrome, protein S deficiency) – Differentiated by abnormal laboratory values in a young patient with multiple recurrent TIA’s/Strokes.
- Vasculitis – differentiated based on laboratory values (elevated sedimentation rate) and angiographic findings. Angiography is normal in patients with CADASIL.


Diagnosis: CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoenceopalopathy)


CADASIL, or cerebral autosomal dominant ateriopathy with subcortical infarcts and leukoenceopalopathy, is a rare (1/100,000) hereditary, non-atheromatous vasculopathy found in young adults. Patients suffer from a autosomal dominant mutation in the NOTCH3 gene, which codes for a large transmembrane receptor that is found in abnormally high concentrations on the surface of vascular smooth muscle cells. Pathologically this manifests as a non-arteriosclerotic amyloid-negative angiopathy primarily affecting perforating and meningeal arteries. Histologically, a characteristic granular osmiophilic material is found in the vascular basal membrane.

This leads to two lesion types that have been described:
- 1) Degenerated and destroyed vascular smooth muscle cells leading to impaired vasodilation in response to hypercarbia
- 2) Fibrous thickening of the arteriolar wall leading to arteriolar narrowing and compromising basal cerebral blood flow

Clinically, common presenting signs and symptoms include recurrent TIAs, cognitive deficits, migraine with aura, depression, and rarely seizures. The classic profile is that of a young adult with recurrent TIAs and a history of migraine with aura. There is no gender predilection.

Imaging findings are most characteristic with MR. T2 and FLAIR images show diffuse white matter and lacunar subcortical hyperintensities. The frontal and temporal lobes as well as the insulae are most commonly involved. Anterior temporal poles and external capsule hyperintensities carry higher diagnostic accuracy for CADASIL. The periventricular white matter and cortex are generally spared, but basal ganglia and brainstem can be involved. T1 images show both large coalescent white matter isointense lesions, as well as small well circumscribed subcortical hypointensities. Digital subtraction angiography is normal, and is done to exclude vasculitis and hypercoagulable states.

Genetic testing for NOTCH3 mutations associated with CADASIL are available. The patient had tested positive for this abnormality, and naturally had a family history of this autosomal dominant disorder.

Useful Radiology Teaching resource

Came across this very useful teaching resource from ACR known as Case in point. I suggest this link all radiology residents especially the ones who are about to appear for their examination. It is very easy to subscribe to the "case in point" via your email.

Link- ACR Case in Point

Gray matter heterotopia and Lipoma

Findings

The lateral ventricles and 3rd ventricle are slightly increased in size. There is heterotopia along the lateral posterior aspect of the body of the L lateral ventricle. There is a posterior midline fatty lesion consistent with lipoma.


Differential diagnosis for the posterior midline findings:
- Lipoma
- Dermoid or teratoma (Should have more heterogeneity and not be as low in overall density)
- Lipomatous differentiation or transformation of neoplasm or cerebellar lipo- neurocytoma (again, more heterogeneous)

Differential diagnosis for the left lateral ventricle finding:
- Gray matter heterotopia
- Tuberous sclerosis subependymal nodules (frequently calcify and enhance)


Diagnosis: Gray matter heterotopia and Lipoma


Key points

Gray matter heterotopias:
- Are migrational disorders.
- Can result in seizures.
- Associated with many syndromes, most commonly Chiari II and agenesis of the corpus callosum.

CNS lipomas:
- Are congenital malformations and not true neoplasms.
- Are due to maldevelopment of the meninx primitive.
- Often associated with agenesis of the corpus callosum.
- About half are seen in the interhemispheric fissure.
- Many calcify, but rarely in the posterior fossa.