PMC4813062_01
Photographs of the infant showing (A) hypertelorism and (B) median cleft palate. A fleshy mass is seen through the defect. The panel of sagittal (C) T1W, (D) T2W and (E) T1W fat-suppressed MRI imags reveals tubo-mamillary fusion (thin white arrows). A large craniopharyngeal canal is seen with a nasopharyngeal mass at its caudal end (solid arrows). The mass is heterogeneously hyperintense on both T1W and T2W images, with signal loss on fat-suppressed images
IJRI-26-126-g001.jpg
PMC4813062_01_IJRI-26-126-g001.jpg
F1
On examination, the baby had hypertelorism [Figure 1A]. A fleshy mass was seen through the cleft and some hemorrhage was also noted on its surface [Figure 1B]. T1W and T2W images were seen within the superior aspect of the mass [Figure 1C-E]. These findings were suggestive of an oropharyngeal teratoma (epignathus teratoma). Tubomamillary fusion (hypothalamic pseudohamartoma) was also noted with thickening of the floor of the third ventricle and two separate infundibular recesses [Figures 1 and 2].
(A) Coronal T1W and (B) T2W MRI images show duplication of the pituitary gland with two pituitary stalks (thin white arrows) and neurohypophyseal "bright" spots (thick white arrows). The optic chiasma is also widened. The floor of the third ventricle is thickened and there are two infundibular recesses (arrows)
IJRI-26-126-g002.jpg
PMC4813062_01_IJRI-26-126-g002.jpg
F2
Note was made of an osseous spine dividing the sella, DPG with two separate pituitary stalks, and widening of the optic chiasma (17.6 mm) [Figure 2]. Tubomamillary fusion (hypothalamic pseudohamartoma) was also noted with thickening of the floor of the third ventricle and two separate infundibular recesses [Figures 1 and 2].
The panel of axial (craniocaudal) CT images in bone window (A-D) reveals a large craniopharyngeal canal (thick white arrows). The duplicated sella with an intervening sellar spine is seen in (A). The narrowed posterior choanae are also seen (thin arrows). Coronal (E) and sagittal (F) reformatted CT images showthe large craniopharyngeal canal (thick black arrows) with dense tooth-like structures
IJRI-26-126-g003.jpg
PMC4813062_01_IJRI-26-126-g003.jpg
F3
The vomer bone was detected to be widened posteriorly with a transverse diameter of 9.3 mm (normally less than 1.5 mm in diameter) with narrowing of the choanae [Figure 3].
(A) T2W axial and (B) maximum intensity projection (MIP) MRI images show duplication of the basilar artery. The superior cerebellar and posterior cerebral arteries are seen originating from the respective ipsilateral basilar artery. (C and D) T2W coronal MRI images show hypoplasia of bilateral olfactory bulbs/tracts (thin white arrows) and anterior clefting of the cervical vertebrae
IJRI-26-126-g004.jpg
PMC4813062_01_IJRI-26-126-g004.jpg
F4
MRI also revealed duplication of the rostral part of the basilar artery with each superior cerebellar and posterior cerebral artery originating from the respective ipsilateral basilar artery [Figure 4A and 4B]. Hypoplasia of bilateral olfactory bulbs [Figure 4C] and anterior clefting of the cervical vertebrae were also noted [Figure 4D].