Rathke cleft cyst
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Low testosterone. Evaluate for pituitary pathology.
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There is a well-circumscribed nonenhancing CSF intensity cyst within the ventral aspect of the anterior pituitary gland which measures 7 x 6 x 6 mm (TRV, AP, CC). The remainder of the pituitary gland displays normal homogeneous enhancement and the pituitary infundibulum is midline. The posterior pituitary bright spot is present, and in normal location.
There is subtle right cerebellar tonsillar ectopia of approximately 6 mm, without significant crowding of the foramen magnum, or evidence of hydrocephalus.
There is no focus of reduced diffusivity or abnormal susceptibility artifact within the brain parenchyma. The corpus callosum and cerebellar vermis are normal in appearance. There is no acute intracranial hemorrhage, acute ischemic changes, mass effect, or extra-axial fluid collection. There is no midline shift or hydrocephalus. The basal subarachnoid cisterns and cerebral sulci are not effaced. The major intracranial flow voids are present, and grossly unremarkable. There is no pathologic intracranial enhancement.
Given the imaging appearance (CSF intensity in ventral pituitary), this lesion likely represents a Rathke cleft cyst. The patient was also incidentally found to have right cerebellar ectopia.
The patient has been following up with endocrinology as an outpatient. Surgery is planned due to the symptomatic nature of the lesion.
Ananth Narayan, MD