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20b - Answer: 60-year-old male presents with possible stroke

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 60-year-old male presents with possible stroke with left visual field deficit.

(QUIZ ANSWER) PRIMARY FINDING: 

Pituitary macroadenoma.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Pituitary macroadenoma compresses the visual pathway and is approximately 2.7cm in height, 1.6cm in AP dimension, and transverse dimension approximately 1.6cm. Both the optic postchiasmatica nerves as well as the optic chiasm and retrochiasmatic tracts are compressed. The mamillary bodies are displaced but not compressed. 

Incidentally noted is cervical arthropathic chronic fibrotic synovial pseudotumor. 

Scant/mild white matter gliosis consistent with small-vessel arteriopathy, venopathy or minimal hypertension is noted. 

No diffusion restriction is noted. 

IMPRESSION:

Pituitary macroadenoma without cavernous sinus invasion, but with suprasellar extension compressing the visual pathway. 

The calvarium is slightly thick and the frontal sinuses are slightly hyperpneumatized and while this may represent a normal variant, such a finding could be seen in growth hormone hypersecretion. In addition the patient has a slightly enlarged uvula and thick mandibular condylar necks.

LESSON 3, TOPIC 30

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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