Rathke cleft cyst with fluid-fluid level

Case contributed by Ammar Haouimi
Diagnosis probable

Presentation

Chronic headaches with no visual disturbances. Prolactin level at 100 ng/mL. To rule out adenoma.

Patient Data

Age: 40 years
Gender: Female
This study is a stack
Sagittal
T1
This study is a stack
Coronal
T1
This study is a stack
Axial
FLAIR
This study is a stack
Coronal
T2
This study is a stack
Coronal
T1 C+
This study is a stack
Sagittal
T1 C+
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Info

There is a well-defined midline cyst (10 x 8 x 6 mm) within the sella with fluid-fluid level seen on sagittal T1 and axial FLAIR. A thin peripheral enhancing rim of surrounding compressed pituitary tissue is noted.

Annotated image
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Info

Annoted image showing the fluid-fluid level within the cyst.

Case Discussion

A fluid-fluid level may be seen in Rathke cysts, particularly if there has been a hemorrhage. Also, It can be a feature of proteinaceous concretions within the cyst fluid. The main differential diagnosis is a hemorrhagic pituitary adenoma.

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