Rathke's cleft cyst
Reason for initial scan uncertain.
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A well-defined T1 isointense T2 hyperintense intra and suprasellar cystic mass is identified. On T2 coronal imaging this demonstrates a 7 mm hypointense intracystic nodule which is mildly T1 hyperintense. Normally enhancing pituitary gland is draped over the anterior right aspect of the cyst with mild elevation and deviation of the infundibulum to the right of midline. The apex of the cyst contacts without displacing the optic chiasm and proximal aspects of the pre-chiasmatic optic nerves. There is no extension into the cavernous sinuses and the cavernous carotid flow voids are maintained.
Conclusion: The imaging features are essentially pathognomonic of a Rathke's cleft cyst.
Fortunately, this patient has not required surgery. Visual fields are normal. The lesion has not changed in 2 years of surveillance.
An intracystic dot or nodule in a pituitary cystic lesion is essentially pathognomonic of a Rathke's cleft cyst.