This 63-year-old male presents with benign neoplasm of pituitary gland and craniopharyngeal duct (pouch).
(QUIZ ANSWER) PRIMARY FINDING:
Rathke cleft cyst.
Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.
Thin walled cystic structure identified in an enlarged sella with surrounding pituitary tissue measuring 1.5 x 1 x 1.6cm. No evidence of nodular enhancement. Homogeneous signal intensity which is nearly isointense with cerebrospinal fluid on T1 weighted imaging. This represents a Rathke cleft cyst. Deviation of the pituitary stalk to the right. The pituitary gland abuts the right prechiasmatic optic nerve.
There are no extraaxial fluid collections, acute intracranial hemorrhage, acute infarction, hydrocephalus, sulcal effacement or midline shift. Tiny FLAIR hyperintensity in the left superior frontal gyrus. No additional parenchymal abnormalities in the cerebral hemispheres, cerebellum or brainstem. No Chiari malformation.
No abnormalities in the cerebellopontine angle cisterns.
Visualized flow voids in the distal internal carotid arteries, distal vertebral arteries, basilar artery, circle of Willis and dural venous sinuses intact.
No abnormalities in the paranasal or mastoid sinuses.
Orbits, visualized face and neck unremarkable.
1. Rathke cleft cyst measuring 1.5 x 1 x 1.6cm in an enlarged sella with otherwise normal appearing surrounding pituitary tissue.
2. Tiny focus of gliosis in the white matter in the left superior frontal gyrus likely microangiopathic in origin from arteriosclerosis or chronic hypertension.