Case #23

CT

• Irregular, heterogeneous pineal region mass with associated calcification and internal hypoattenuating areas
• Associated mass effect on the cerebral aqueduct with obstructive hydrocephalus and subependymal edema about the third and lateral ventricles

MRI

• Heterogeneous pineal region mass measuring 2.4 x 2.3 x 2.3 cm which bulges into the posterior aspect of the third ventricle and exerts downward mass effect on the tectum with obstruction of the cerebral aqueduct
• Patchy internal areas of restricted diffusion and enhancement
• Susceptibility artifact corresponding with the areas of calcification on CT
• Additional site of abnormal soft tissue centered in the chiasmatic and infundibular recesses of the third ventricle, which may represent a separate tumor or intraventricular tumor spread
• Obstructive hydrocephalus involving the lateral and third ventricles with subependymal edema