Radiology Case Reports (Nov 2024)

Pituitary abscess occurring 12 years after transsphenoidal surgery for Rathke's cleft cyst

  • Hisato Ishii, MD,
  • Shin Ito, MD,
  • Shinichiro Teramoto, MD,
  • Natsuki Sugiyama, MD,
  • Hideaki Ueno, MD,
  • Satoshi Tsutsumi, MD

Journal volume & issue
Vol. 19, no. 11
pp. 4974 – 4977

Abstract

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A 73-year-old man who previously underwent transsphenoidal surgery for a Rathke's cleft cyst presented with headache and fever. Ophthalmological examination revealed the progression of visual impairment. Cerebral magnetic resonance imaging revealed a cystic mass in the sellar and suprasellar regions with rim-like enhancement. An intralesional hyperintense area with temporal enlargement was identified using serial diffusion-weighted imaging. Lumbar cerebrospinal fluid tap findings indicated bacterial meningitis. The patient had undergone a transsphenoidal surgery; an intraoperatively implanted sheet of artificial dura mater from the previous surgery was identified adjacent to the sellar floor. After incising the floor, the pus material was drained and methicillin-sensitive Staphylococcus aureus was identified on culture. Consecutive antibiotic treatment resolved the pituitary abscess (PA). PA may develop as a late complication of transsphenoidal surgery, particularly when an artificial material is implanted during surgery. Clinical signs coupled with temporal findings on diffusion-weighted sequences can facilitate the diagnosis and activity of PA and serve as a guide for proper management.

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