Case Challenge

Head and Neck

Neuro

Sella

Stephen J Pomeranz

Gain confidence interpreting Sella MRI Cases with MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME!

Case Review

Neuroradiology

Case 1 - 76-year-old male presents with hemianopia and mass

Case 2 - 43-year-old female presents history of pituitary microprolactinoma

Case 3 - 21-year-old male presents with visual field defect

Case 4 - 42-year-old male presents with moderate to severe headaches

Case 5 - 53-year-old female presents with Rathke's cleft cyst

Case 6 - 46-year-old female presents with papilledema

Case 7 - 78-year-old female presents with headaches and pituitary lesion

Case 8 - 64-year-old female presents with severe intermittent left-sided headaches

Case 9 - 61-year-old male presents with hypogonadism

Case 10 - 9-year-old female presents with intractable headaches

Case 11 - 63-year-old female presents with right retroorbital pain, paresthesia

Case 12 - 67-year-old female presents with enlarged sella with intermittent anosmia

Case 13 - 13-year-old male presents with blurred vision

Case 14 - 63-year-old male presents with dizziness for four weeks

Case 15 - 46-year-old female presents with papilledema

Case 16 - 40-year-old female presents with history of left lower quadrant visual loss

Case 17 - 48-year-old female presents with headache

Case 18 - 54-year-old male presents with pituitary cyst

Case 19 - 35-year-old male presents with mild to moderate dizziness

Case 20 - 38-year-old male presents with pituitary macroadenoma

Case 21 - 33-year-old male presents with headaches

Case 22 - 56-year-old male presents with possible stroke

Case 23 - 61-year-old female presents with memory loss

Case 24 - 63-year-old male presents with benign neoplasm of pituitary gland

Case 25 - 31-year-old male presents with papilledema

Course Evaluation

Post-Course Activities

This Power Pack is comprised of 25 unique Sella MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Sella MRI Cases

<div>HISTORY:&#160;This 21-year-old male presents with visual field defect.(QUIZ ANSWER) MOST LIKELY DIFFERENTIAL OF THE MASS:&#160;Craniopharyngioma.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS: Large sellar and suprasellar mass measuring 3.2cm superior to inferior, 1.8cm transverse and 1.3cm anterior to posterior which enlarges the sella turcica and extends into the 3rd ventricle with uplifting and compression of the optic apparatus, anterior displacement of the anterior cerebral complex. The lesion is T1 hyperintense without enhancement on postcontrast images and demonstrates a nonenhancing mural nodule. The pituitary tissue within the sella is downwardly compressed with enhancing pituitary tissue compressed anteriorly. The lesion extends to the cavernous sinuses bilaterally without evidence of cavernous sinus invasion. The superior portion of the lesion is slight asymmetric to the right. No retroclival extension. Posterior extension of the lesion elevates the tuber cinereum and effaces the supraoptic recess.No transependymal spread of CSF or sulcal effacement.&#160;No supportive findings of chemical meningitis. No temporal horn prominence. No abnormal meningeal enhancement.&#160;No diffusion restriction.&#160;No air-fluid levels in the paranasal sinuses.&#160;Cerebral hemispheres and deep nuclei are without hemorrhage or mass. No Chiari malformation.&#160;No enhancing internal auditory canal masses.&#160;No enlargement of the extraocular muscles.&#160;No enhancing parenchymal masses.&#160;CONCLUSION:&#160;1. Large T1 hyperintense sellar and suprasellar mass which appears to compress enhancing pituitary tissue and enlarge the sella. The lesion has a small mural nodule which may be calcified. The superior portion of the lesion extends into the 3rd ventricle without other supportive findings of ventricular obstruction. The optic apparatus is superiorly compressed and the anterior communicating artery complex is anterior and superiorly displaced. T1 hyperintensity may be consistent with proteinaceous or lipid content.&#160;2. Differential includes craniopharyngioma, adamantinomatous type most likely, large Rathke's cleft cyst less likely. CT may be considered to provide further definition as the presence of calcification would be more characteristic of craniopharyngioma than a Rathke's cyst.&#160;</div>

Case

In this case, there is a sellar and suprasellar mass which appears to compress enhancing pituitary tissue and enlarge the sella. Which of the following is the MOST LIKELY differential of the mass?