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5b - Answer: 53-year-old female presents with Rathke's cleft cyst

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files


This 53-year-old female presents with Rathke's cleft cyst, headaches, and visual changes.



Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


There is a round T1 hypointense and mixed T2 intensity nonenhancing right suprasellar mass at the dorsal aspect of the pituitary gland and adjacent to the infundibulum measuring 5 mm. This lesion causes leftward deviation and thinning of the infundibulum and contacts the undersurface of the right optic chiasm without displacement. Given differences in technique of the prior exam (IMAGES NOT SHOWN HERE), this lesion appears stable in size. Cavernous sinuses enhance normally.

Basilar cisterns, ventricles, and sulci are normal in size and configuration. No hydrocephalus or midline shift.

A few stable scattered foci of T2 / FLAIR hyperintensity within the periventricular and subcortical white matter. The brain parenchymal signal is otherwise unremarkable. No restricted diffusion to suggest acute or subacute infarction. No intra-axial or extra-axial mass. No intracranial hemorrhage or fluid collection. No blood-degradation products on susceptibility-weighted imaging. No abnormal intracranial enhancement.

Midline structures are normal. Posterior fossa and craniocervical junction are normal. Visualized intracranial flow voids are maintained. Orbits are unremarkable.

Mild mucosal thickening within the ethmoidal sinuses. The remaining visualized paranasal sinuses are well aerated. Mastoid air cells are clear. Bone marrow signal intensity of the clivus and calvarium is unremarkable. Visualized soft tissues are normal.


1. Nonenhancing round 5 mm suprasellar mass, as described above, with differential considerations including Rathke's cleft cyst, microadenoma, and less likely/ unlikely pituicytoma, spindle cell oncocytoma. This lesion is stable when compared to the prior examination (IMAGES NOT SHOWN HERE), given differences in technique. Consider 6-12 month follow up and exclusion of hormone malfunction specifically DI- diabetes insipidus. No neurophyphyseal bright spot is noted. No enhancement therefore germinoma and stalkitis- lymphoid hypophysitis virtually excluded. 

2. No acute intracranial abnormality or pathologic enhancement.

3. Mild stable scattered foci of T2 / FLAIR hyperintensity within the white matter that are likely secondary to migraines or chronic microvascular ischemia and less likely differential considerations include demyelination, vasculitis or Lyme disease.

4. Mild ethmoidal sinus disease.


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Content reviewed: July 15, 2021

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