Hyperdense Suprasellar Mass



Hyperdense Suprasellar Mass


Anne G. Osborn, MD, FACR



DIFFERENTIAL DIAGNOSIS


Common



  • Pituitary Macroadenoma


  • Aneurysm



    • Saccular Aneurysm


    • Fusiform Aneurysm, ASVD


  • Meningioma


Less Common



  • Craniopharyngioma


  • Rathke Cleft Cyst


  • Germinoma


  • Neurosarcoid


Rare but Important



  • Parenchymal Metastases


  • Primary CNS Lymphoma


  • Pilomyxoid Astrocytoma


  • Tuberculosis


  • Fungal Diseases


  • Chordoid Glioma


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Is mass from pituitary gland or other structure?


Helpful Clues for Common Diagnoses



  • Pituitary Macroadenoma



    • Approximately 10% hyperdense



      • Cellularity, hemorrhage


    • Pituitary gland can’t be separated from mass



      • Gland is the mass


  • Saccular Aneurysm



    • Nonthrombosed aneurysms slightly hyperdense to brain


    • Partially/completely thrombosed aneurysms may be very hyperdense


  • Fusiform Aneurysm, ASVD



    • May involve either ICA or BA


    • Nonaneurysmal dolichoectasia common in older patients


    • ASVD > non-ASVD (e.g., inherited vasculopathy, AIDS-related, etc.)


    • ASVD often Ca++


  • Meningioma



    • 10% in sellar/suprasellar region


    • Pituitary gland separate from mass


Helpful Clues for Less Common Diagnoses



  • Craniopharyngioma



    • Children: Adamantinomatous type



      • Usually cystic, Ca++


      • Rarely hyperdense


    • Adults: Papillary type more common



      • Iso/slightly hyperdense


      • Solid, rarely calcified


  • Rathke Cleft Cyst



    • Only 10% purely suprasellar, hyperdense


  • Germinoma



    • Mildly hyperdense to brain


    • Look for pineal mass (but can be primary infundibulum/3rd ventricle lesion)


Alternative Differential Approaches



  • Hyperdense suprasellar mass with Ca++



    • Children: Craniopharyngioma


    • Adults: Aneurysm, meningioma

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