Presentation
Known, treated hyperprolactinemia, on prior dynamic sella MRI an about 5 mm lesion was visible in the left adenohypophysis, suggestive of hemorrhagic microadenoma/Rathke's cleft cyst.
Patient Data
Adjacent to floor of the sella and slightly to the left an about 12 x 10 x 9 mm rounded, inhomogeneous lesion can be discerned. Note its striking, intrinsic T1/T2 hyperintensity. It displaces the pituitary tissue, and results in the cranial bulge of the latter. The lesion shows no increased enhancement post contrast. The pituitary stalk deviates to the right.
Other depicted structures are unremarkable. Incidental low-lying tonsil, extending approximately 3 mm below the foramen magnum.
Annotated image showing the measurement of the relative positions of the tonsils.
Case Discussion
The marked, spontaneous T1/T2 hyperintensity of the cystic lesion is most likely in line with a Rathke's cleft cyst with significant amount of proteinaceous content.