Diagnosis please !!

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BENIGN VERTEBRAL COLLAPSE

Case history :  Elderly female with back pain of 1 week duration.

Discussion : Benign Vs Malignant Vertebral Collapse.

Fatty filum terminale

 

LIPOMA OF FILUM TERMINALE

Persistence of caudal cells that differentiate toward fat could produce filar lipomas. The presence of fat within the filum terminal may be observed incidentally in 4% to 19% of normal adults and may be considered a normal variation if the fat is not associated with cord tethering or neurologic dysfunction.

Typically, fatty fila thicker than 2 mm are regarded as filar lipomas.They exhibit increased signal intensity on T1-weighted images and progressively lower signal intensity with greater T2 weighting and are easily observed on good sagittal and axial sections.
(Ref : Scott Atlas, 4th, 2009).

This is sometimes also called as fibrolipoma of filum terminale. Conus medullaris has to be normal in position.     (Ref : Differential Diagnosis in MRI, Burgener).

Choroid Fissure Cyst

 9 year old male child for follow-up scan of an incidentally detected right temporal lobe cyst.

Choroid fissure cyst is a benign intracranial cyst, which is a location based diagnosis, rather than a histological one. Cysts can be an arachnoid cyst or a neuro-epithelial cyst. The cyst shows signal characteristics that resemble CSF in all sequences. No enhancement on contrast is seen. There will no surrounding hyperintensity.

The choroidal fissure is the CSF space between the fimbria of hippocampus and the diencephalon. This is normally a shallow fissure that curves posterosuperiorly from the anterior temporal lobe to the atrium of lateral ventricle. Tela choroidea is a double layer of pia mater that invaginated through the choroid fissure to reach the lateral ventricles.

Ref : MRI of CSF-like Choroidal fissure and parenchymal cysts of brain, AJNR 1990.

Arachnoid cyst of Septum Pellucidum

5 year old male child presented with complaints of ?seizures.
MRI Brain were within normal limits excepting the cystic enlargement of the septum pellucidum.

 

Arachnoid cysts account for ~1% of all intracranial masses.

On imaging, they are characterized as well circumscribed cysts, with an imperceptible wall, displacing adjacent structures, and following the CSF pattern (hypodense on CT and hyperintense on T2 with FLAIR suppression on MRI).


References
1. Radiopaedia.org
2. Arachnoid cyst of septum pellucidum  

Periventricular Leukomalcia Vs Normal PV Blush

Periventricular Leukomalcia Vs Normal Periventricular Blush
- Normally the periventricular area can be slightly echogenic.

- Early PVL appears as periventricular increased echogenicity ( PV area- Watershed area in premature babies and Posterior Parieto-Occipital areas are watershed areas in Term Infants).


To differentiate remember this --
"Echogenicity that is less echogenic than the adjacent choroid plexus is considered   to be normal.Coarse, echogenic areas equal to or greater than that of the adjacent choroid are suspicious for PVL. When in doubt, scanning through the posterior fontanelle will eliminate the normal periventricular blush, whereas the pathological echogenicity of PVL will persist."