Rathke cleft cyst - with dot sign

Case contributed by A.Prof Frank Gaillard

Presentation

Vague headaches.

Patient Data

Age: 55 years
Gender: Male

MRI pituitary

Modality: MRI

A cystic lesion measuring 9 x 10 x 12 millimetres occupies the anterior part of the pituitary fossa, displacing the normal pituitary tissue posteriorly and somewhat to the left. It is of low signal intensity on T1, does not enhance, and is of high signal intensity on T2 and demonstrates a 2 to 3 mm hypointense nodule anteroinferiorly. 

The optic chiasm may be just contacted in the midline by the dome of the cyst. There is no evidence of extension into the cavernous sinuses.

Scattered throughout the white matter of both cerebral hemispheres, particularly in the frontal lobes, are regions of high T2 signal, which are non-specific but most likely relate to chronic small vessel ischaemic change.

Annotated image

Modality: Annotated image

T2 hyperintense cyst (yellow dotted line) contains a small inferior T2 hypointense nodule (green arrow). The dome of the cyst just or almost touches the optic chiasm (blue). 

Case Discussion

This case demonstrates typical appearances of a Rathke cleft cyst, including the small hypo-intense 'dot' sign, which is said to be pathognomonic. 

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Case Information

rID: 16835
Case created: 23rd Feb 2012
Last edited: 6th Nov 2015
Inclusion in quiz mode: Included

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