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Blake Pouch Cyst
Anne Kennedy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Blake pouch cyst (BPC)
            • Definitions

              • Persistent cystic evagination of the area membranacea under inferior vermis in cerebellar vallecula due to nonperforation of foramen of Magendie
              • Diagnostic criteria
                • Normal vermian size, anatomy in midline sagittal view
                • < 30° anticlockwise rotation of vermis
                • Normal size of cisterna magna (CM)
                • CM septa may be bowed laterally
                • 4th ventricle (V4) choroid plexus (CP) at superior margin of BPC
              • A Blake pouch (BP) is a normal embryological structure quite frequently seen with modern equipment

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  • Reporting Tips

                                    Selected References

                                    1. AIUM practice parameter for the performance of detailed diagnostic obstetric ultrasound examinations between 12 weeks 0 days and 13 weeks 6 days. J Ultrasound Med. ePub, 2020
                                    2. Kau T et al: Blake's pouch cysts and differential diagnoses in prenatal and postnatal MRI: a pictorial review. Clin Neuroradiol. 30(3):435-45, 2020
                                    3. Garcia-Rodriguez R et al: First-trimester cystic posterior fossa: reference ranges, associated findings, and pregnancy outcomes. J Matern Fetal Neonatal Med. 1-10, 2019
                                    4. Paladini D et al: Hindbrain morphometry and choroid plexus position in differential diagnosis of posterior fossa cystic malformations. Ultrasound Obstet Gynecol. 54(2):207-14, 2019
                                    5. Pertl B et al: The fetal posterior fossa on prenatal ultrasound imaging: normal longitudinal development and posterior fossa anomalies. Ultraschall Med. 40(6):692-721, 2019
                                    6. Martinez-Ten P et al: Non-visualization of choroid plexus of fourth ventricle as first-trimester predictor of posterior fossa anomalies and chromosomal defects. Ultrasound Obstet Gynecol. 51(2):199-207, 2018
                                    7. Wüest A et al: Enlarged posterior fossa on prenatal imaging: differential diagnosis, associated anomalies and postnatal outcome. Acta Obstet Gynecol Scand. 96(7):837-43, 2017
                                    8. D'Antonio F et al: Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal imaging (part 2): neurodevelopmental outcome. Ultrasound Obstet Gynecol. 48(1):28-37, 2016
                                    9. Azab WA et al: Blake's pouch cyst. Surg Neurol Int. 5:112, 2014
                                    10. Contro E et al: Open fourth ventricle prior to 20 weeks' gestation: a benign finding? Ultrasound Obstet Gynecol. 43(2):154-8, 2014
                                    11. Leibovitz Z et al: Assessment of fetal midbrain and hindbrain in mid-sagittal cranial plane by three-dimensional multiplanar sonography. Part 2: application of nomograms to fetuses with posterior fossa malformations. Ultrasound Obstet Gynecol. 44(5):581-7, 2014
                                    12. Paladini D et al: Abnormal or delayed development of the posterior membranous area of the brain: anatomy, ultrasound diagnosis, natural history and outcome of Blake's pouch cyst in the fetus. Ultrasound Obstet Gynecol. 39(3):279-87, 2012
                                    13. Volpe P et al: Brainstem-vermis and brainstem-tentorium angles allow accurate categorization of fetal upward rotation of cerebellar vermis. Ultrasound Obstet Gynecol. 39(6):632-5, 2012
                                    14. Malinger G et al: The fetal cerebellum. Pitfalls in diagnosis and management. Prenat Diagn. 29(4):372-80, 2009
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Blake pouch cyst (BPC)
                                              • Definitions

                                                • Persistent cystic evagination of the area membranacea under inferior vermis in cerebellar vallecula due to nonperforation of foramen of Magendie
                                                • Diagnostic criteria
                                                  • Normal vermian size, anatomy in midline sagittal view
                                                  • < 30° anticlockwise rotation of vermis
                                                  • Normal size of cisterna magna (CM)
                                                  • CM septa may be bowed laterally
                                                  • 4th ventricle (V4) choroid plexus (CP) at superior margin of BPC
                                                • A Blake pouch (BP) is a normal embryological structure quite frequently seen with modern equipment

                                              IMAGING

                                              • General Features

                                                • Ultrasonographic Findings

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Gross Pathologic & Surgical Features

                                                            CLINICAL ISSUES

                                                            • Presentation

                                                              • Natural History & Prognosis

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  • Image Interpretation Pearls

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. AIUM practice parameter for the performance of detailed diagnostic obstetric ultrasound examinations between 12 weeks 0 days and 13 weeks 6 days. J Ultrasound Med. ePub, 2020
                                                                      2. Kau T et al: Blake's pouch cysts and differential diagnoses in prenatal and postnatal MRI: a pictorial review. Clin Neuroradiol. 30(3):435-45, 2020
                                                                      3. Garcia-Rodriguez R et al: First-trimester cystic posterior fossa: reference ranges, associated findings, and pregnancy outcomes. J Matern Fetal Neonatal Med. 1-10, 2019
                                                                      4. Paladini D et al: Hindbrain morphometry and choroid plexus position in differential diagnosis of posterior fossa cystic malformations. Ultrasound Obstet Gynecol. 54(2):207-14, 2019
                                                                      5. Pertl B et al: The fetal posterior fossa on prenatal ultrasound imaging: normal longitudinal development and posterior fossa anomalies. Ultraschall Med. 40(6):692-721, 2019
                                                                      6. Martinez-Ten P et al: Non-visualization of choroid plexus of fourth ventricle as first-trimester predictor of posterior fossa anomalies and chromosomal defects. Ultrasound Obstet Gynecol. 51(2):199-207, 2018
                                                                      7. Wüest A et al: Enlarged posterior fossa on prenatal imaging: differential diagnosis, associated anomalies and postnatal outcome. Acta Obstet Gynecol Scand. 96(7):837-43, 2017
                                                                      8. D'Antonio F et al: Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal imaging (part 2): neurodevelopmental outcome. Ultrasound Obstet Gynecol. 48(1):28-37, 2016
                                                                      9. Azab WA et al: Blake's pouch cyst. Surg Neurol Int. 5:112, 2014
                                                                      10. Contro E et al: Open fourth ventricle prior to 20 weeks' gestation: a benign finding? Ultrasound Obstet Gynecol. 43(2):154-8, 2014
                                                                      11. Leibovitz Z et al: Assessment of fetal midbrain and hindbrain in mid-sagittal cranial plane by three-dimensional multiplanar sonography. Part 2: application of nomograms to fetuses with posterior fossa malformations. Ultrasound Obstet Gynecol. 44(5):581-7, 2014
                                                                      12. Paladini D et al: Abnormal or delayed development of the posterior membranous area of the brain: anatomy, ultrasound diagnosis, natural history and outcome of Blake's pouch cyst in the fetus. Ultrasound Obstet Gynecol. 39(3):279-87, 2012
                                                                      13. Volpe P et al: Brainstem-vermis and brainstem-tentorium angles allow accurate categorization of fetal upward rotation of cerebellar vermis. Ultrasound Obstet Gynecol. 39(6):632-5, 2012
                                                                      14. Malinger G et al: The fetal cerebellum. Pitfalls in diagnosis and management. Prenat Diagn. 29(4):372-80, 2009