Axial T2 (image 1), T1 postcontrast (image 2), and FLAIR (im | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Axial T2 (image 1), T1 postcontrast (image 2), and FLAIR (image 3) MRI of the brain in an asymptomatic adolescent with an epidermoid cyst shows a cystic lesion involving the right superior frontal gyrus. There is no significant effect on the underlying brain with minimal adjacent edema or mass effect. The mass does not enhance, has mild heterogeneous signal on the FLAIR sequence, and showed restricted diffusion (not shown). Epidermoid cysts most commonly occur at the cerebellar pontine angle or the region of the fourth ventricle. Characteristic features include the heterogeneous signal on FLAIR sequence and restricted diffusion. #NeuroWednesday

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Sagittal T1 and T2 weighted (image 1) and diffusion weighted (image 2) MR images of the spine shows a spinal epidermoid (arrow) at the L4 level. Spinal epidermoids are uncommon but account for approximately 10% of intraspinal tumors in children. They can be associated with segmentation anomalies. They're characterized on imaging with similar signal characteristics to fluid. The intense restricted diffusion is a key feature of the lesion.](https://app.figure1.com/case-detail/4a1ad608-2176-4675-b79c-e3db30cf06af)

Axial diffusion-weighted (image 1) and apparent diffusion coefficient (ADC) map (image 2) show the lesion (arrow) of the left middle cranial fossa restricts diffusion. This is a common location for an arachnoid cyst. However, an arachnoid cyst should follow cerebral spinal fluid on all imaging sequences including diffusion-weighted imaging.
Intracranial epidermoid cysts can mimic an arachnoid cyst. They are differentiated from arachnoid cysts by their restricted diffusion. The ADC map helps to confirm that there is true restricted diffusion and not just T2 shine through.
#FridayQuizDay #Quiz #FridayQuiz](https://app.figure1.com/case-detail/6f6d1df7-c988-462e-ad98-795d2d67b1b7)

Sagittal MR in a 6 year old with an occipital “bump” shows a soft tissue lesion (blue arrow) that connects through the bone and communicates with a midline, heterogeneous mass in the posterior fossa, an epidermoid (red arrows). These lesions are nonneoplastic and occur during neural tube closure from epidermal rests or inclusions, such as skin. They diffusion restrict on MR. #NeuroWednesday](https://app.figure1.com/case-detail/8ac85548-655e-4b19-87a3-c7a0b07dd09b)

Complex left cerebellar hemisphere mass in a 10-year old shows marked diffusion restriction on the apparent diffusion coefficient (ADC) image (blue arrow) and hyperintensity on the diffusion image (red). Although juvenile pilocytic astrocytomas are common complex hemispheric lesions in pediatrics, the marked diffusion restriction makes a high grade lesion such as a medulloblastoma much more likely. Diffusion-weighted imaging is a key imaging sequence to help determine grade of pediatric brain tumors, as many may show little to no enhancement or adjacent edema, as here. #NeuroWednesday](https://app.figure1.com/case-detail/a60103fe-c8de-4f59-bd09-31ba67620260)

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He had a history of hypertension, long-term smoking, and a sedentary lifestyle.
On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

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Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

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patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)