Purpose or Case Report: Objective:
Describe the embryologic origin and developmental anatomy of the torcular pathology.
Identify the key MRI and MR venography characteristics of torcular pseudomass that distinguish it from dural venous sinus thrombosis and other posterior fossa lesions.
Recognize the typical clinical scenarios in which torcular pseudomass is discovered and understand its benign, self-limiting natural history.
Learning Points:
Torcular pseudomass is a benign, self-limiting developmental variant in infants, not true mass.
Appears midline, as a non-enhancing, extra-axial soft-tissue prominence posterior to the torcular Herophili on MRI
Differential diagnoses include dural venous sinus thrombosis, dermoid cyst, and neoplasm.
No enhancement or venous obstruction on MRV distinguishes it from thrombosis.
Follow-up is rarely required unless associated abnormalities are suspected.
Recognition of this entity prevents unnecessary imagination or surgical intervention.
Most cases resolve spontaneously by 12–18 months of age.
Discussion:
Torcular pseudomass is a non-pathologic developmental variant located posterior to the torcular Herophili, the confluence of dural venous sinuses. It represents persistent mesenchymal tissue that fails to fully regress after birth. While uncommon, it is increasingly recognized with the wider use of MRI in infants. This benign entity typically appears between 2–6 months of age and resolves spontaneously within the first year of life. The overall prevalence is unknown, but literature shows on MRI series estimate Torcular pseudomass is found an incidental in up to 1–2% of pediatric neuroimaging studies.
Awareness of this variant is essential, as it can be mistaken for dural venous sinus thrombosis, dermoid cyst, or posterior fossa tumor. Misdiagnosis may lead to unnecessary interventions such as anticoagulation or biopsy.
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