Case #24

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