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Think you’ve got the diagnosis? Think again!!
This is a case where the diagnosis is not as important as the lesson it teaches you.
Watch the video and then check back for hidden portion of this post to see what the answer is...
And what lesson you should have learned from it !
Avidly enhancing T2 dark lesions in the subependymal region with increased diffusion signal. If I said that description to you—even without seeing the images—you would say lymphoma!
Was that your answer? It was mine!
And we are both wrong!
It turned out to be metastatic melanoma.
But the lesson here is that just because you were wrong by pathology, doesn’t mean you were wrong on the imaging
If I saw a case like this again, I would still say lymphoma!
You won’t be right every time—there will be weird cases.
But you are making a bet on the imaging appearance and you should always bet the odds—with the risk that every now and then you might be wrong!
So don’t remember from this case that metastases can look like lymphoma—remember that sometimes it’s ok to be wrong as long as you read the case right
Veins are like defense, arteries like offense.
Arteries get all the glory & attention, but you're nothing w/o veins
It's important to check dural venous sinuses on every MRI, not just venograms
If you're not looking at veins on brain MRIs, you're missing things!
Here's the anatomy you need to know in the sagittal plane:
▶️Superior sagittal sinus:
Appropriate name—it goes along the sagittal midline superiorly!
▶️Inferior sagittal sinus:
Also appropriate name--it goes along the sagittal midline inferiorly!
▶️Straight sinus:
Appropriate name—it runs a straight along the tentorium
🌟Remember, tents need straight poles to hold them up so there is a straight sinus beneath the TENTorium
▶️Internal cerebral veins:
Appropriate name, comes from the more internal or central part of the cerebrum
▶️Vein of Galen:
Connects the internal cerebral veins to the straight sinus
🌟I call it the Vein of Get-In—it’s how the deep venous system GETs IN to the straight sinus
▶️Torcula:
Where all the deep and superficial system meet
🌟I think torcula sounds like Dracula & Dracula drinks all the blood—so this is where all the blood goes!
Now when it comes to dural venous sinus anatomy, you will always be in the right vein!