Diagnosis: Precocious pubertyClinical question: brain abnormality responsible for sexual precocity?Signs and Symptoms: sexual precocity MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an extra-axial cystic lesion present along the anterior middle cranial fossa on the right side measuring 23 x 11 mm in axial dimensions. It follows spinal fluid on all pulse sequences.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening.. The visualized portions of the mastoid air cells demonstrate opacities in the mastoid air cells and middle ears bilaterally. The nasopharyngeal tonsils are large. The visualized portions of the orbits are intact.MRI pituitary:There is a 7 x 7 mm sagittal dimension mass w located at the tuber cinereum. It is lower in signal intensity relative to white matter on the T1-weighted images. It is heterogeneous in appearance on T2-weighted images and it is high signal on FLAIR imaging. It has a small cystic component. It enhances heterogeneously on post gadolinium imaging. It is visually contiguous with the infundibulum of the pituitary gland. There is no associated susceptibility effect.The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally.
1.There is a hypothalamic mass present. Differential considerations include craniopharyngioma as well as germinoma and primary brain tumor. Granulomatous disorder is less likely.2.There is an arachnoid cyst present in the right middle cranial fossa.3.There are opacities in the middle ears and mastoid air cells associated with large tonsils which may represent retained secretions of the possibility of otitis media can't be excluded.