Demographics:
19 years old, Male
Indication:
Newly diagnosed hydrocephalus
Findings
CT
- Mildly hyperattenuating pineal region mass with internal calcification
- Associated obstructive hydrocephalus at the level of the cerebral aqueduct
- Right frontal approach external ventricular drain terminating in the third ventricle
- Multifocal areas of calvarial thinning, particularly involving the bilateral greater sphenoid wings and squamous temporal bones and the cribriform plate
MRI
- Avidly, somewhat heterogeneously enhancing pineal region mass measuring 2.7 x 2 x 3 cm which engulfs the pineal calcification and exerts downward mass effect on the tectum resulting in obstructive hydrocephalus
- Mild corresponding T1 signal hypointensity
- T2 signal intensity and restricted diffusion are similar to gray matter
- Left frontal approach ventricular drainage catheter
- Right mastoid effusion
Annotated Images & Illustrations
Mildly hyperattenuating pineal region mass (red arrow) which engulfs the pineal calcification (yellow arrow).
Multiple areas of calvarial thinning (red arrows), likely the result of longstanding elevated intracranial pressure.
Corresponding avid but heterogeneous enhancement (red arrow).
Diagnosis
Germinoma (pineal region)
Key Imaging Features
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Differential Diagnosis
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Discussion
Pearls
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