I Can't Believe it's Not Cancer! Torcular Pseudomass: A Not-So-MASSive Problem After All?

Document Type

Conference Proceeding

Publication Date

5-9-2025

Abstract

Torcular pseudomass describes the incidental finding of a benign collection of soft tissue observed in the torcular region, or the confluence of venous sinuses in the occipital region of the brain. At first glance, these findings can be cause for concern as they mimic the appearance of distressing pathologies such as a mass lesion. This finding has thus far only been identified in pediatric patients under the age of three. Due to the few indications for head imaging in this population, identification of torcular pseudomasses as well as quantification of their relative frequency has only recently been explored. Dissemination of information about the nature of torcular pseudomasses aims to grow awareness of their existence, which will reduce the need for follow up/unnecessary imaging (and therefore radiation exposure) and provide reassurance to the caregivers of affected patients.

This case study describes the hospital and imaging course of a 13-month-old male who initially presented to the emergency department with seizure-like activity and encephalopathy. During his neurological workup, he was found to have a concerning-appearing mass on diagnostic brain imaging. Through subsequent imaging, clinical examination, and literature research, the patient was determined to have a torcular pseudomass, a (likely) common phenomenon in children under three that is underreported due to a lack of imaging in this age group. This finding was determined to be unrelated to the patient's seizure activity or encephalopathy, both of which he recovered from quickly.

Torcular pseudomasses appear to present without neurological symptoms and to the best of current knowledge do not represent a pathological or clinical issue. At this point in medical understanding, they are an incidental finding in young children. It is unclear what the cause of this finding is; however, proposed origins generally indicate a developmental stage of connective or osseous tissue suggestive of a normal anatomical variant. Given their location, these pseudo masses may represent a variant in mesenchymal development of the epidural space, an area of embryonic development that remains poorly understood. A 2022 paper by Miranda et al conducted a retrospective study of fetal MRIs that established a presence of torcular pseudomasses in 92% of the observed fetuses, suggestive that this is a finding that frequently involutes in utero but, as in the case of our patient, can persist into toddlerhood.

Torcular pseudomass is likely a highly underreported finding that, while frightening in appearance, is ultimately a benign occurrence representing a common and what is likely an underexplored phase in brain development. By increasing knowledge of this finding, it is our hope that when it is observed on future scans, it will not be cause for panic in caregivers or their providers but rather identified as the benign finding that it is. Ultimately, this will aid in decreasing unnecessary follow up imaging and undue emotional burden on the families and patients involved.

Comments

2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1650

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