Clinics in diagnostic imaging (103). Dural sinus thrombosis with cerebral venous infarction.

A 13-year-old boy had a history of severe headache for two weeks. He also had seizures and vomited many times. Neurological examination was normal except for bilateral papilloedema. Sagittal T1-weighted magnetic resonance (MR) images showed loss of the normal flow void in the superior sagittal sinus. There was hyperintensity, which came from subacute thrombosis in the posterior half of the superior sagittal sinus. MR venography confirmed loss of flow signal in the superior sagittal sinus. There was also thrombosis of the right transverse, right sigmoid, and left transverse sinuses, and haemorrhagic infarctions in the right frontal and left parietal regions. A diagnosis of dural sinus thrombosis with cerebral venous infarction was made. CT, MR imaging, MR venography, and CT venography findings are discussed in patients with cerebral venous thrombosis.

Clinics in diagnostic imaging (96). Plexiform neurofibromatosis.

A 10-year-old boy presented with a mass on the left side of his face for many years, left ear deafness, and limited vision in the left eye. Enhanced CT of the face and neck showed a multilobulated low attenuation mass in the left parotid space, with nodularity and involvement of branches of the left facial nerve. There was a mass in the left orbital apex that extended into the left cavernous sinus, exopthalmos of the left eye, and erosion of the medial portion of the greater wing of the left sphenoid. Partial removal of the mass in the left parotid space was performed. Histopathological examination revealed plexiform neurofibromas. CT and MR imaging findings in neurofibromatosis type 1 patients with craniofacial abnormalities are discussed.

Clinics in diagnostic imaging (81). Hypothalamic glioma with diencephalic syndrome.

A 15-month-old boy presented with failure to thrive. Physical examination revealed third degree malnutrition. MR imaging showed a large lobulated mass in the suprasellar region. The mass was hypointense on T1-weighted MR images, hyperintense on proton density-weighted and T2-weighted MR images, and enhanced homogeneously. The patient underwent a craniotomy for a subtotal resection of the tumour. Histopathological examination revealed a juvenile pilocytic astrocytoma that caused the diencephalic syndrome. Clinical presentation and imaging findings of the various tumours or diseases that can cause suprasellar masses in children are discussed and illustrated via further examples.

Clinics in diagnostic imaging (75). HIV encephalopathy and cerebral aneurysmal arteriopathy.

A six-year-old girl with vertically-transmitted HIV infection had hyperreflexia. MR imaging showed diffuse prominence of the subarachnoid spaces and ventricles caused by HIV encephalopathy. Fusiform dilatation of the supraclinoid segment of the right internal carotid artery was also noted. MR angiography confirmed cerebral aneurysmal arteriopathy. Imaging findings of the various cerebral manifestations and complications found in children with AIDS coming from the primary effects of HIV, opportunistic infections, tumours, and vascular disease are discussed.

Clinics in diagnostic imaging (78). Cardiac rhabdomyoma in tuberous sclerosis.

A seven-day-old boy with a family history of tuberous sclerosis presented with congestive heart failure. Cardiac-gated magnetic resonance (MR) imaging showed a mass in the right atrium, which was T1-isointense and T2-hyperintense relative to myocardium. Follow-up echocardiographical studies showed a decrease in the number and size of the nodules. Finally, no cardiac nodules were seen when he was two years and eleven months old. The echocardiographical studies, MR imaging findings and the clinical history are consistent with cardiac rhabdomyomas. MR imaging of the brain also showed multiple subependymal nodules, white matter abnormalities, and cortical tubers. The varied imaging appearances of tuberous sclerosis are discussed and illustrated with additional examples.