Calcified Suprasellar Mass



Calcified Suprasellar Mass


Anne G. Osborn, MD, FACR



DIFFERENTIAL DIAGNOSIS


Common



  • Atherosclerosis, Intracranial


  • Craniopharyngioma


  • Meningioma


  • Aneurysm



    • Saccular Aneurysm


    • Fusiform Aneurysm, ASVD


Less Common



  • Neurocysticercosis


  • Pilocytic Astrocytoma


  • Dermoid Cyst


Rare but Important



  • Pituitary Macroadenoma


  • Tuberculosis


  • Chondroid Tumor


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Is Ca++ curvilinear, punctate, globular, etc.?


  • Does lesion enhance?


Helpful Clues for Common Diagnoses



  • Atherosclerosis, Intracranial



    • Curvilinear Ca++


    • Usually bilateral


    • Often multifocal


    • Older patients


  • Craniopharyngioma



    • Globular, punctate, &/or ring Ca++


    • Younger patients (older adult tumors more often solid, Ca++ less frequent)


  • Meningioma



    • Psammomatous (sand-like) Ca++


    • Solid > rim enhancement


    • Middle-aged, older patients (unless NF2)


  • Aneurysm



    • Saccular Aneurysm



      • Calcification less common than with fusiform aneurysm, ASVD


      • Curvilinear (peripheral arcs, rings) pattern


    • Fusiform Aneurysm, ASVD



      • Linear ± rim Ca++


      • Ca++ often present in other vessels


Helpful Clues for Less Common Diagnoses



  • Neurocysticercosis



    • Nodular calcified stage


    • Usually parenchymal > > cisternal Ca++


  • Pilocytic Astrocytoma



    • Common in children, young adults


    • Ca++ uncommon in hypothalamic PA


  • Dermoid Cyst



    • 20% have capsular Ca++


    • Contain lipid


    • Look for evidence of rupture (fatty droplets in subarachnoid spaces, cisterns)


    • No enhancement unless chemical meningitis


Helpful Clues for Rare Diagnoses



  • Only 1-2% of macroadenomas calcify


  • TB, healing/healed granulomatous infections cause parenchymal > > cisternal Ca++


  • Chondromas, enchondromas arise from central base of skull






Image Gallery









Axial NECT shows a fusiform, partially calcified mass in the suprasellar cistern image that represents an ectatic, supraclinoid, internal carotid artery with calcified atherosclerotic plaque.

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Calcified Suprasellar Mass

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