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12b - Answer: 67-year-old female presents with enlarged sella with intermittent anosmia

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

HISTORY: 

This 67-year-old female presents with enlarged sella with intermittent anosmia.

(QUIZ ANSWER) MOST LIKELY FINDING: 

Idiopathic intracranial hypertension.

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

FINDINGS:

Extensive peri- and non-periventricular white matter hyperintensity most compatible with small vessel arteriopathy and / or venopathy secondary to hypertension and/or arteriosclerosis and demonstrating atypical distribution and pattern for primary de- or dysmyelination. 

Complete empty sella has enlarged the sella turcica. Tortuosity of the optic nerves raises the possibility of intracranial idiopathic hypertension previously known as pseudotumor cerebri creating a dotted-i appearance of the optic nerves. 

No tonsillar sagging is appreciated and the ventricular size is not altered. 

Bilateral maxillary sinus mucoperiosteal thickening with left-sided floor retention cyst. 

Bilateral panethmoiditis more severe posteriorly than anteriorly with ethmoidal opacification posteriorly. 

Diffuse sphenoid mucoperiosteal thickening. 

Right-sided frontal sinus mucoperiosteal thickening. 

Blood-sensitive imaging shows no evidence of prior microhemorrhage. Diffusion imaging is unremarkable. No acute infarcts identified. 

CONCLUSION: 

1. Complete empty sella with tortuous optic nerves and slightly dilated sheaths raising the possibility of idiopathic intracranial hypertension previously known as pseudotumor cerebri, perhaps excluded with funduscopic examination. 

2. No signs of pituitary adenoma, micro or macro. 

3. Moderate angiopathic white matter signal alteration. Differential diagnosis given above. 

4. Extensive sinus disease detailed above, most severe in the ethmoid distribution.

LESSON 2, TOPIC 36

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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