Presentation
Headache
Patient Data
A midline cystic lesion, measuring 16x9x8 mm, is seen involving the pituitary gland. An intracystic tiny nodule involves the left anterior inferior aspect of the cyst. Posterior to this nodule, there is a septation involving the left aspect of the cyst. There is peripheral enhancement of the cyst which could be related to the compressed pituitary tissue. The lesion causes upward convexity of the pituitary, however, there is no mass effect on the optic chiasm. There is no extension into the adjacent cavernous sinuses. No fluid-fluid level could be detected within the cyst.
Selected axial and coronal T2WI demonstrate the isointense intracystic nodule (white arrows).
Case Discussion
MRI findings are consistent with Rathke's cleft cyst (RCC). The main differential diagnosis is cystic pituitary adenoma.
Findings in favor of Rathke's cleft cyst:
- an intracystic nodule (highly suggestive)
- midline location within the gland
- no fluid-fluid level
- no septation (in this case, there is a septation, however, the midline location and intracystic nodule favor the diagnosis of Rathke's cleft cyst
Findings in favor of cystic pituitary adenoma:
- off-midline location
- a fluid-fluid level
- septations
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