Case Presentation

Pericallosal lipoma with agenesis of corpus callosum

Dr. Anusha.R, 2nd year post graduate, Department Of Radio-

Diagnosis

Clinical details

17 year old male patient was referred from Miryalguda to the department of Radio-Diagnosis for evaluation of seizures using MRI Brain.

Presenting complaints

Patient was suffering from seizure’s since childhood. Past history : No history of any head trauma, tuberculosis, diabetes, no history of any fever with rash or any other diseases. Addictions : no history of any smoking or alcohol consumption.

Investigations

• Routine Haematological investigations were unremarkable.

• Chest X-ray showed normal study. • Ultrasound abdomen showed no sonological

abnormality. • All the above investigations were done outside.

MRI BRAIN FINDINGS

T1W Mid Sagittal image showing Complete absence of corpus callosum & absent cingulate gyrus.

Normal T1 Mid Sagittal image

T1 Para Saggital & axial showing hyperintense lesion in anterior pericallosal region

T1 Coronal - VIKING HELMET SIGN – pointed upturned lateral ventricles with high riding 3rd ventricle

T2 axial images showing parallel orientation & widely separated lateral ventricle – RACING CAR SIGN

T2 Axial Images show dilated occipital horns COLPOCEPHALY – RABBIT EAR SIGN

T2 STIR showing Fat suppression of anterior pericallosal lesion – suggestive of lipoma

SWI, Phase Contrast images show blooming & hyperintensity in the periphery of pericallosal lipoma- s/o calcification

Axial CT Brain showing fat density(-100 HU) lesion with peripheral calcification in anterior pericallosal region

CT Brain bone window - peripheral bracket shaped calcification

AP RADIOGRAPH SKULL - BRACKET SIGN

Imaging findings MRI Brain : Complete absence of corpus callosum • Parallel, non converging lateral ventricles • Dilated occipital horns of lateral ventricles • T1,T2 hyperintense,Extra-axial lobular lesion seen

in the midline in the anterior pericallosal region with suppression on STIR sequences & peripheral blooming on SWI

CT BRAIN : • extra- axial fat density lesion seen in midline in

anterior pericallosal region with peripheral calcifications with complete absence of corpus callosum.

Differential diagnosis: for pericallosal lipoma 1.Intracranial dermoid cyst : usually 20-30 HU, signal intensity is more heterogenous, no associated malformations, calcification is common 2.Intracranial teratoma: more heterogenous in appearance, show solid & cystic components, solid component shows contrast enhancement.

Final Diagnosis: Tubulonodular variety of pericallosal lipoma with peripheral calcifications & complete agenesis of corpus callosum.

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