Computed Tomographic and Magnetic Resonance Imaging Findings in the Midline Nasopharyngeal Glial Heterotopia

Case Series

Austin J Radiol. 2015;2(2): 1015.

Computed Tomographic and Magnetic Resonance Imaging Findings in the Midline Nasopharyngeal Glial Heterotopia

Junfang Xian*

Department of Radiology, Capital Medical University, China

*Corresponding author: Junfang Xian, Department of Radiology, Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaominxiang Street, District of Dongcheng, Beijing 100730, China

Received: January 06, 2015; Accepted: March 11, 2015; Published: March 17, 2015

Abstract

The glial Heterotopia is a rare developmental abnormality in the nasopharynx. We report two girls with this lesion. CT and MR imaging demonstrated an ovoid heterogeneously pedunculated mass attached to the left nasopharyngeal wall by a stalk of fibrous tissue, with no extension into the cranial vault. Scattered patchy fat tissues and pituitary tissues found in the glial heterotopia in one case were reported for the first time. Multiplanar images with multidetector CT, especially sagittal CT images never reported in the glial Heterotopia, might be very helpful in evaluating the adhesion between the mass and the structures in the nasopharynx, whether the bony defect of the skull base, and whether the communication between the mass and the intracranial structures.

Keywords: Glial heterotopia; Nasopharynx; Computed Tomography; Magnetic resonance imaging

Introduction

Glial heterotopia, used to refer to ectopic central nervous tissue arising as a developmental malformation, is a rare developmental abnormality seen in a wide age group but typically presenting at birth or in early childhood [1]. The most frequently affected site is the nasal area [2]. Less commonly, brain heterotopias have been reported in the tongue [3], palatopharyngeal complex [4-6], orbit [7,8], scalp [9], ear [10] and cervical spaces such as the infratemporal space [1,11] and the pterygopalatine fossa [12]. The glial Heterotopia in the nasopharynx has rarely been reported [4,6]. We herein present two additional cases of glial heterotopia arising in the nasopharynx and describe CT and MR imaging findings, in which fat tissues and pituitary tissues contained in the glial heterotopia were reported for the first time in this paper adding new information for the glial heterotopia. Moreover, Multiplanar images with multidetector CT, especially sagittal CT images never reported in the glial heterotopia, can be very helpful in evaluating the adhesion between the mass and the structures in the nasopharynx, whether the bony defect of the skull base, and whether the communication between the mass and the intracranial structures.

Case 1

A one year and three month old girl presented with nasal obstruction associated with mouth breathing and dyspnea during sleeping since birth. On physical examination, a 20x10 mm gray reddish mass above the soft palate in the nasopharynx obstructing the choana concurrently with cleft soft palate was seen. Multiplanar images including coronal, sagittal, and axial sections on 64-detector CT revealed a 22x21x16 mm heterogeneously isodense and hypodense ovoid mass attached to the left nasopharyngeal wall by a pedicle of fibrous tissue lying above the soft palate (Figure 1A, B). No communication between the mass and the intracranial structures or bony defect of the skull base was noted. On MR imaging, the mass showed mixed hyperintense and isointense signal intensity to the brain tissue on T1-weighted images (Figure 1C) and mixed hyper intense and isointense signal intensity on T2-weighted images with hyper intense regions on T1-weighted images becoming hypointense signal intensity on MR fat suppression images. No connection between the mass and the intracranial structures was demonstrated on MR imaging, either. No adhesion was found between the mass and the soft palate. Incomplete cleft soft palate was concurrently observed. The mass obstructed the nasopharyngeal cavity.