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26b - Answer: 68-year-old male is under evaluation for pituitary disorder

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

HISTORY: 

This 68-year-old male is under evaluation for pituitary disorder.

(QUIZ ANSWER) PRIMARY FINDING: 

Capillary telangiectasia.

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

FINDINGS:

Pituitary bright spot is indistinct. Pituitary height of 5mm is within one standard deviation of the mean for patient age. No nodularity or thickening of the pituitary stalk. No cavernous sinus invasion. No focal hypointensity within the pituitary on postcontrast images. No macroadenoma. 

Periventricular hyperintensities may represent gliosis of microangiopathic origin. Hyperintense lesion within the left middle cerebellar peduncle measuring 1.6cm. Subtle hyperintensity within the left pons. Left-sided lesion demonstrates postcontrast enhancement. 

No obstructive hydrocephalus. No extra-axial collections or hemorrhage. 

No Chiari malformation. 

Prominent perivascular spaces within the cerebral peduncles. 

Small cisterna magna pouch. 

Diffusion-weighted images are without a diffusion-restrictive defect. 

IMPRESSION:

No pituitary macroadenoma. No discrete microadenoma on postcontrast images. 

Pituitary bright spot is indistinct. Finding may be relevant if diabetes insipidus is of clinical concern. 

Hyperintense lesion within the pons and left cerebral peduncle without edema could represent low-flow vascular malformations of capillary telangiectasia type. No other evidence of parenchymal demyelination. Six to twelve week followup is recommended to monitor lesional behavior if prior images are not available.

LESSON 3, TOPIC 48

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Content reviewed: July 23, 2021

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