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Table of Contents    
NEUROIMAGES
Year : 2018  |  Volume : 66  |  Issue : 6  |  Page : 1846-1847

Pericallosal lipoma masquerading as venous thrombosis on magnetic resonance imaging


1 Department of Radiology, Yashoda Superspeciality Hospital, Malakpet, Hyderabad, Telangana, India
2 Department of Neurology, Yashoda Superspeciality Hospital, Malakpet, Hyderabad, Telangana, India

Date of Web Publication28-Nov-2018

Correspondence Address:
Dr. Ravi K Jakkani
Department of Radiology, Yashoda Superspeciality Hospital, Near Nalgonda Cross Roads, Malakpet, Hyderabad - 500 036, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.246253

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How to cite this article:
Jakkani RK, Reddy K K, Satyanarayan S, Suryanarayana A, Ramineni KK. Pericallosal lipoma masquerading as venous thrombosis on magnetic resonance imaging. Neurol India 2018;66:1846-7

How to cite this URL:
Jakkani RK, Reddy K K, Satyanarayan S, Suryanarayana A, Ramineni KK. Pericallosal lipoma masquerading as venous thrombosis on magnetic resonance imaging. Neurol India [serial online] 2018 [cited 2018 Dec 14];66:1846-7. Available from: http://www.neurologyindia.com/text.asp?2018/66/6/1846/246253




A 60-year old female patient, who was diabetic and hypertensive, came to the neurology outpatient department with complaints of headache and giddiness since 1 month. On examination, she was conscious and coherent with a normal sensorium. There were no sensory or motor deficits and the cranial nerve examination was normal. Her fundus examination was unremarkable. Magnetic resonance imaging (MRI) of the brain was advised for further evaluation. MRI showed two curvilinear T1 and T2 hyperintense cord-like structures seen in the pericallosal region with blooming visible on the gradient reversal echo (GRE) sequence, along the location of inferior sagittal sinus [Figure 1]. The lesion on MRI was closely simulating either inferior sagittal sinus thrombosis or the presence of a pericallosal lipoma. Plain computed tomography (CT) of brain showed a thin curvilinear fat-containing lesion corresponding to the MRI lesion [Figure 2] which confirmed the diagnosis of a pericallosal lipoma.
Figure 1: Serial axial T1 weighted (a-c) and gradient echo (d–f) images of the brain showing two T1 hyperintense cord-like structures in the pericallosal region (black arrows) with blooming on gradient echo images (white arrows)

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Figure 2: Sagittal T1 weighted (a) and sagittal plain computed tomography (b) images of the brain showing a curvilinear T1 hyperintense pericallosal lesion (black arrow) with the corresponding fat lesion on computed tomography (white arrow)

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Pericallosal region is the most common location of an intracranial lipoma. These lipomas are divided into the curvilinear and the tubulonodular subgroups. They are asymptomatic and can be associated with corpus callosal anomalies like hypoplasia and agenesis.[1] Pericallosal lipomas are seen along vascular structures like the inferior sagittal sinus and can mimic the presence of a venous sinus thrombosis on MRI. They show a hyperintense signal on T1 and T2 sequences and often show blooming on GRE sequence, masquerading venous thrombosis.[2] Lipomas often show susceptibility artifacts attributed due to microscopic mineralization and thus cause blooming on GRE sequences.[3] T1 and T2 fat-saturated images are also useful for establishing the diagnosis of a lipoma. Chemical shift artifact helps in diagnosing fat-containing lesions. This finding appears because of the difference in the resonance frequencies of fat and water and is seen in the frequency-encoding direction. It is seen in short spin-echo, GRE, and susceptibility-weighted imaging sequences and appears as a dark line at the fat and fluid interface.[4] The CT scan can easily differentiate these lipomas from other vascular lesions and confirms the diagnosis by showing a fat-containing lesion, as seen in our case.

A pericallosal lipoma can mimic a venous thrombosis on MRI. Knowledge of MRI features of a lipoma in various pulse sequences is very useful in establishing the diagnosis; plain CT scan can confirm the diagnosis in cases where the diagnosis is not immediately apparent on an MR imaging.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yilmaz MB, Genc A, Egemen E, Yilmaz S, Tekiner A. Pericallosal lipomas: A series of 10 cases with clinical and radiological features. Turk Neurosurg 2016;26:364-8.  Back to cited text no. 1
    
2.
Ogul H, Pirimoglu B, Ozbek S, Kantarci M. The pericallosal lipoma mimicking deep cerebral vein thrombus. BMJ Case Rep 2013;2013. doi: 10.1136/bcr-2013-010025.  Back to cited text no. 2
    
3.
Lingegowda D, Rajashekar C, Belaval VV, Thomas B, Keshavdas C, Kapilamoorthy. Susceptibility artifacts in lipomas. Neurol India 2013;61:56-9.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Sadashiva N, Tiwari S, Narayan V, Shukla D. Ruptured intracranial dermoid and the chemical shift artifact. J Neurosci Rural Pract 2016;7:86-7.  Back to cited text no. 4
[PUBMED]  [Full text]  


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