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Think youโve 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 youโeven without seeing the imagesโyou 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, doesnโt mean you were wrong on the imaging
If I saw a case like this again, I would still say lymphoma!
You wonโt be right every timeโthere will be weird cases.
But you are making a bet on the imaging appearance and you should always bet the oddsโwith the risk that every now and then you might be wrong!
So donโt remember from this case that metastases can look like lymphomaโremember that sometimes itโs 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:
โถ๏ธSuperior sagittal sinus:
Appropriate nameโit goes along the sagittal midline superiorly!
โถ๏ธInferior sagittal sinus:
Also appropriate name--it goes along the sagittal midline inferiorly!
โถ๏ธStraight sinus:
Appropriate nameโit runs a straight along the tentorium
๐Remember, tents need straight poles to hold them up so there is a straight sinus beneath the TENTorium
โถ๏ธInternal cerebral veins:
Appropriate name, comes from the more internal or central part of the cerebrum
โถ๏ธVein of Galen:
Connects the internal cerebral veins to the straight sinus
๐I call it the Vein of Get-Inโitโs how the deep venous system GETs IN to the straight sinus
โถ๏ธTorcula:
Where all the deep and superficial system meet
๐I think torcula sounds like Dracula & Dracula drinks all the bloodโso this is where all the blood goes!
Now when it comes to dural venous sinus anatomy, you will always be in the right vein!