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 53-year-old female presents with Rathke's cleft cyst, headaches, and visual changes.(QUIZ ANSWER) LEAST LIKELY DIFFERENTIAL OF MASS:&#160;Pituicytoma.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS:&#160;There is a round T1 hypointense and mixed T2 intensity nonenhancing right suprasellar mass at the dorsal aspect of the pituitary gland and adjacent to the infundibulum measuring 5 mm.&#160;This lesion causes leftward deviation and thinning of the infundibulum and contacts the undersurface of the right optic chiasm without displacement.&#160;Given differences in technique of the prior exam (IMAGES NOT SHOWN HERE), this lesion appears stable in size.&#160;Cavernous sinuses enhance normally.Basilar cisterns, ventricles, and sulci are normal in size and configuration.&#160;No hydrocephalus or midline shift.A few stable scattered foci of T2 / FLAIR hyperintensity within the periventricular and subcortical white matter.&#160;The brain parenchymal signal is otherwise unremarkable.&#160;No restricted diffusion to suggest acute or subacute infarction.&#160;No intra-axial or extra-axial mass. No intracranial hemorrhage or fluid collection. No blood-degradation products on susceptibility-weighted imaging.&#160;No abnormal intracranial enhancement.Midline structures are normal. Posterior fossa and craniocervical junction are normal. Visualized intracranial flow voids are maintained. Orbits are unremarkable.Mild mucosal thickening within the ethmoidal sinuses.&#160;The remaining visualized paranasal sinuses are well aerated.&#160;Mastoid air cells are clear.&#160;Bone marrow signal intensity of the clivus and calvarium is unremarkable.&#160;Visualized soft tissues are normal.CONCLUSION:1. Nonenhancing round 5 mm suprasellar mass, as described above, with differential considerations including Rathke's cleft cyst, microadenoma, and less likely/ unlikely pituicytoma, spindle cell oncocytoma.&#160;This lesion is stable when compared to the prior examination (IMAGES NOT SHOWN HERE), given differences in technique. Consider 6-12 month follow up and exclusion of hormone malfunction specifically DI- diabetes insipidus. No neurophyphyseal bright spot is noted. No enhancement therefore germinoma and stalkitis- lymphoid hypophysitis virtually excluded.&#160;2. No acute intracranial abnormality or pathologic enhancement.3. Mild stable scattered foci of T2 / FLAIR hyperintensity within the white matter that are likely secondary to migraines or chronic microvascular ischemia and less likely differential considerations include demyelination, vasculitis or Lyme disease.4. Mild ethmoidal sinus disease.</div>

Case

Which of the following is the LEAST LIKELY differential of the suprasellar mass in this case?