Osteolipoma of tubercinerium: An incidental finding in a patient with schizophrenia

A 45-year-old male patient with clinically suspected schizophrenia was referred for an MRI brain to look for organicity. An incidental lesion was noted on the right side of the tubercinerium with suspicious findings of osteolipoma. T1 and T2 weighted sequences showed a hyper-intense lesion suggestive of fatty intensity or hemorrhage. A homogenous blooming artefact was seen on gradient imaging suggestive of a calcific/hemorrhagic element. The referring clinician was conveyed the findings asking about the need for further imaging by CT. The patient was started on antipsychotics for schizophrenia. One week later, a CT head was obtained, which showed a fatty density lesion with a smooth, peripheral rim of hyperdensity. The HU value matched rim calcification suggesting radiological diagnosis of osteolipoma. The patient was kept under close observation and no specific therapy was guided to this lesion. The patient was responding well to pharmacotherapy (in terms of control of symptoms) confirming osteolipoma as an incidental finding. This case report establishes the role of adequate imaging in subtle brain lesions which may mimic primary lesion-producing neurological symptoms. The importance of clinical judgment and follow-up in guiding suitable therapy is also highlighted.