Rathke’s cleft cyst pre and post operative status.

T2 coronal pituitary image pre operative at the level of sella tursica / shows a well circumscribed hyper intense signal lesion arising from the sella and extends to supra sellar area.

T2 sagital pituitary image pre operative at the level of sella tursica / shows a well circumscribed hyper intense signal lesion arising from the sella and extends to supra sellar area; here we can see that this lesion is causing mild impression on the optic chiasm.

PROTOCOL:    Thin 3 mm T1W Sagittal & Coronal scans (Pre and post gadolinium contrast)
       T2W axial sections for screening of brain were also       obtained.
FINDINGS:

Evidence of a focal space occupying lesion is seen in the region of the suprasellar and sellar area which is compressing the pituitary stalk and gland. This lesion is bright on the T1 , T2 as well as FLAIR images. There are no solid components. There is no obvious enhancement. The lesion measures 11.5mm in the anterioposterior diameter and 15.4 mm in the vertical diameter and 11 mm in the transverse diameter. There is a thinning of the anterior lobe of the pituitary gland.

The optic chiasma is normal in size, position and appearance.

Infundibulum is in midline.

Para sellar structures show normal MR morphology and signal intensity.

Brain parenchyma shows normal grey white matter differentiation.

Ventricles are normal in position and size.

Brain stem and cerebellum are normal in appearance.

Bilateral mastoiditis is seen.

OPINION

• Sellar and suprasellar cystic lesion which is showing signal typical characteristics of a Rathke’s cleft cyst with compression of the neighbouring glandular parenchyma and the pituitary stalk. A remote differential diagnosis being a hemorrhage in a pituitary adenoma. Please correlate with the hormonal investigations.
• Incidental bilateral mastoiditis.

Post operative study:

PROTOCOL:
Thin 3 mm T1W Sagittal & Coronal scans (Pre and post gadolinium contrast) for sella
T2W coronal scans for sella
T1W & T2W axial sections for brain
FLAIR coronal scans for brain

FINDINGS:

-Post operative status pituitary MR imaging revealed:
• Complete disappearance of the previously mentioned cyst in 18 / 02 / 2014.
• Focal defect in the right side of gland probably post operative.
• Centralized pituitary stalk.
• Post operative bone marrow edema of the underlying clivus.

-Brain parenchyma shows normal grey white matter differentiation.
-Ventricles are normal in position and size.
-Brain stem and cerebellum are normal in appearance.


OPINION:

• Post operative status with complete removal of previously mentioned cyst.


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