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14b - Answer: 63-year-old male presents with dizziness for four weeks

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

HISTORY: 

This 63-year-old male presents with dizziness for four weeks. History of melanoma removed.

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

Partial empty sella.

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

FINDINGS:

Mass within the clivus extending into the sphenoid with area of heterogeneous T2 hyperintensity and central isointensity. Central soft tissue demonstrates postcontrast enhancement. The lesion measures approximately 2.8 x 1.7 x 1.7cm and expands the base of the pituitary and upper portion of the clivus to partially fill the sphenoid. There is partial empty sella. No suprasellar masses. 

No masses within the masticator, parapharyngeal or pharyngeal mucosal spaces. 

No evidence of siderosis. 

No other enhancing calvarial masses. 

No evidence of leptomeningeal seeding. 

No extraaxial collections or hemorrhage. 

No obstructive hydrocephalus. 

No evidence of diffusion restriction on diffusion-weighted images. 

No internal auditory canal or cerebellopontine angle masses. 

Venous sinuses are patent. 

Brainstem and cerebellum are without hemorrhage, mass, edema or gliosis. 

Scattered subcortical hyperintensities may represent gliosis of microangiopathic origin without evidence of acute ischemia on diffusion-weighted images. 

CONCLUSION: 

1. T2 hyperintense partially enhancing expansile clival lesion which extends into the sphenoid. Differential could include chordoma, invasive adenoma, myeloma, metastasis. CT may be considered to provide further definition. Fibrous dysplasia may be less likely given morphology and patient demographic. 

2. Scattered subcortical hyperintensities may represent gliosis of microangiopathic origin without evidence of acute ischemia on diffusion-weighted images. 

3. No internal auditory canal or cerebellopontine angle masses. 

4. No evidence of acute supra- or infratentorial ischemia or demyelination. 

5. Venous sinuses are patent.

LESSON 2, TOPIC 42

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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