Tuberculosis is a devastating disease and has shown resurgence in recent years with the advent of acquired immunodeficiency syndrome. Central nervous system involvement is the most devastating form of the disease, comprising 10% of all tuberculosis cases. The causative organism, Mycobacterium tuberculosis, incites a granulomatous inflammatory response in the brain, the effects of which can be appreciated on magnetic resonance imaging (MRI), which can thus be used for diagnosis of the same. Neurotuberculosis can present in various patterns, which can be identified on MRI. The meningeal forms include leptomeningitis and pachymeningitis. Parenchymal forms of neurotuberculosis include tuberculoma in its various stages, tubercular cerebritis and abscess, tubercular rhombencephalitis, and tubercular encephalopathy. Each pattern has characteristic MRI appearances and differential diagnoses on imaging. Complications of neurotuberculosis, usually of tubercular meningitis, include hydrocephalus, vasculitis, and infarcts as well as cranial nerve palsies. Various MRI sequences besides the conventional ones can provide additional insight into the disease, help in quantifying the disease load, and help in differentiation of neurotuberculosis from conditions with similar imaging appearances and presentations. These can enable accurate and timely diagnosis by the radiologist and early institution of treatment in order to reduce the likelihood of permanent neurological sequelae.
Haemangioma is the most common benign tumour of the liver. However, an exophytic hepatic haemangioma, especially the pedunculated form, is very rare. Giant pedunculated haemangiomas are prone to complications because of the narrow size of the pedicle. A large number of lesions can potentially present as exophytic liver masses, and accurate diagnosis can sometimes be challenging. We report a case of an incidentally discovered asymptomatic giant pedunculated liver haemangioma in the region of the lesser sac in a prospective renal donor, which was initially suspected to be a gastrointestinal stromal tumour of the stomach wall. Multiphasic computed tomography and confirmatory magnetic resonance imaging scans ultimately revealed the true nature of the lesion, which turned out to be an exophytic pedunculated hepatic haemangioma from the left lobe of the liver. The lesion was then surgically resected and histopathologically confirmed to be a haemangioma. The patient subsequently underwent successful renal donation as planned. Being a benign lesion with characteristic imaging features, accurate radiological diagnosis is absolutely essential for the appropriate management of such atypical haemangiomas.
Meningiomas are the most common primary non-glial intracranial neoplasms. In most cases, meningiomas have typical imaging appearances and locations, enabling a straightforward radiological diagnosis. However, a myriad of unusual appearances potentially complicate the imaging picture. Furthermore, certain imaging features can also predict the specific histopathological nature and WHO grade of the meningioma. 'Typical' meningiomas include meningothelial, fibrous, and transitional variants and have the characteristic imaging features described for meningiomas. Several 'atypical' variants exist, which, although less common, also generally have a less favourable prognosis and necessitate early diagnosis. In addition, meningiomas can occur in a variety of unusual intracranial and even extra-cranial locations and need to be distinguished from the more common tumours of these regions on imaging. Any associated oedema or haemorrhagic changes may alter the prognosis and have to be carefully assessed and reported. Cystic changes in meningiomas have been divided into five subtypes, and accurate characterisation is essential to predict the prognosis. An extensive review of the several possible variations in imaging appearances of meningiomas including the differential features of common and uncommon variants would facilitate informative radiological reporting of meningiomas. This would be expected to improve pre-operative planning prior to surgical biopsy and thereby improve disease prognosis and patient outcomes.
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