Sagittal T1-weighted MRI shows abnormal thickening of the pi | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Sagittal T1-weighted MRI shows abnormal thickening of the pituitary infundibulum (arrow, image 1). There is also posteriorly inferior displacement of the posterior pituitary bright spot. This is in contradistinction to a normal-appearing infundibulum (arrow, image 2). Langerhans cell histiocytosis can affect the pituitary infundibulum and causes diabetes insipidus. On MRI, the most common findings of pituitary involvement of Langerhans cell histiocytosis include the absence of the posterior pituitary bright spot and infundibular thickening. #NeuroWednesday

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Coronal (image 1) and sagittal (image 2) T1-weighted images focused on the pituitary show a thickened proximal infundibulum (arrow) with increased signal and narrowing distally. Langerhans' cell histiocytosis can rarely affect the central nervous system. When the central nervous system is affected, it most commonly appears as thickening of the infundibulum. Patients may present with diabetes insipidus.](https://app.figure1.com/case-detail/0d4c72e0-2d1e-416c-a522-83b96089935d)


Axial (image 1), coronal (image 2), and sagittal (image 3) T1-weighted post-contrast MRI focused on the pituitary show thickening of the infundibulum (arrow) and enlargement of the pituitary (arrowhead). Langerhans cell histiocytosis rarely affects the central nervous system. When it does, patients may present with diabetes insipidus, ataxia, or hydrocephalus. Diabetes insipidus is a common manifestation when the posterior pituitary and infundibulum are infiltrated by Langerhans cells. Infundibular thickening greater than 3 mm is suggestive of involvement.](https://app.figure1.com/case-detail/1673d4d6-8149-4771-a77e-1f2ed3716ef6)


Sagittal T1 image in a 3 year old girl with central diabetes insipidus shows a thickened pituitary infundibulum (red arrow) and absent T1 bright posterior pituitary (blue arrow). In children, Langerhans cell histiocytosis (LCH), as in this case, and germinoma are the primary considerations. The infundibulum is the most frequent location for intracranial LCH involvement. #NeuroWednesday](https://app.figure1.com/case-detail/4b435df2-2efd-476b-95f2-a0177ca0c2e3)


Chest radiograph in an adolescent with pulmonary Langerhans cell histiocytosis shows multiple pulmonary cysts and a left pneumothorax. Subsequent chest CT (image 2) shows variable-sized cysts throughout the lungs. Pulmonary Langerhans cell histiocytosis is a smoking-related disorder that primarily affects young adults. On CT, patients have variable-sized cysts with irregular walls and septal thickening. Patients may present with a spontaneous pneumothorax. #ThoraxThursday #ThoracicThursday](https://app.figure1.com/case-detail/591f9f16-7f81-4413-9136-5426ceeaf0e7)