Tuber Cinereum Hamartoma

MRI showing non-enhancing hypothalamic mass located between mammillary bodies and infundibulum at the tuber cinereum. Mass represents Tuber Cinereum Hamartoma, also known as Hypothalamic Hamartoma (HH). It is a non-neoplastic congenital gray matter heterotopia. It can be associated with characteristic gelastic seizures - laughing epilepsy. It is a classic case for all sort of radiology exams!

Proton Density in Multiple Sclerosis

It is well known that Proton Density sequence is valuable in evaluation of Multiple Sclerosis (MS) plaques located under tentorium cerebelli. Proton Density (PD) - also known as second echo from T2 sequence, is something we get "for free" with normal T2. However compared to "pure T2" the "double echo T2" is somehow degraded in quality. But the price is worth to pay. Note this plaque laterally on the left side in the pons. It is much better depicted on this scan from 3T MRI compared to T2 and FLAIR. I like FLAIR (third image) as the most "sensitive" sequence for detection of plaques. However PD is "the king" under tentorium.

Also, do not forget the Sagittal T2 showing characteristic "Dawson Fingers" in the other MS patient. We use 3mm slice sequence covering corpus callosum and adjacent structures. I prefer it to volume (3D) sagittal FLAIR.

PML in HIV - Cerebellum

HIV patient with poor immune status presents with gait disturbance and dysdiadochokinesia. MRI reveals asymmetric primary white matter changes mostly in the left cerebellum. Note high signal on T2 and FLAIR as well as some volume increase and discrete contrast enhancement. Radiological signs together with clinical status correspond with Progressive Multifocal Leukoencephalopathy (PML). Diagnosis is not easy since HIV patients can suffer from other opportunistic infections and lymphoma. Clue here is asymmetry, infratentorial location and patient's clinical status. (See Fig 18.16 MRI of Brain and Spine, S. W. Atlas, 4th, p 943). You might also check my previous PML cases: PML 1, PML 2.

Incisive Canal Cyst on CT

Incidental, benign finding on CT showing cyst in the trajectory of the incisive canal representing Incisive Canal Cyst, aka Nasopalatine Duct Cyst. Clues here are well defined borders and location. Developmental anomaly.

Snus on CT

Unfortunately it is very popular in Sweden to use small tobacco bags placed under the upper lip - locally known as Snus. When I saw for the first time a nice Swedish lady placing such tobacco bag under her lip during a meeting - I was shocked with disgust. Note snus bag under the lip as "incidental finding" on the above CT.

This case expands "my collection" of various objects found in patient's mouth.

You might check my previous: Chewing Gum on CT and Candy Under the Tongue on CT.