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18b - Answer: 54-year-old male presents with pituitary cyst

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

HISTORY: 

This 54-year-old male presents with pituitary cyst.

(QUIZ ANSWER) IS A FINDING IN THIS CASE: 

All of the above.

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

FINDINGS:

Marked enlargement of the sella. T1 hypointense, T2 hyperintense nonenhancing area within the sella with posterior and right lateral displacement of the pituitary stalk measures 2.1cm superior to inferior, 2cm anterior-posterior and 1.9cm transverse. Peripheral to this area of cyst formation is an area of T1 and T2 hyperintensity without attenuation on FLAIR sequences which may represent proteinaceous fluid or remote blood products. This area is adjacent to the cystic portion and measures 2.7cm anterior posterior, 8mm in thickness and 1.7cm in transverse dimension. Lateral to this area within the right lateral and inferior sella is an area of heterogeneous hypointensity with nodular enhancement measuring 1.8cm transverse and 1.6cm anterior-posterior. No cavernous sinus thickening.

The optic chiasm is deviated to the left and pulled inferiorly. The chiasm is uplifted and flattened.

No abnormal meningeal enhancement.

Ethmoid sinus mucosal thickening. Frontal sinus mucosal thickening. No extra-axial collections or hemorrhage.

Cisterna magna pouch.

Cerebral hemispheres and deep nuclei are without hemorrhage or mass. Scattered parenchymal hyperintensities may represent gliosis of microangiopathic origin.

No enlargement of the extra-ocular muscles.

Venous sinuses are patent.

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

Carotid and basilar artery flow voids are intact.

Cerebral hemispheres and deep nuclei are without hemorrhage, mass or edema.

CONCLUSION:

Complex multicompartment lesion involving an enlarged sella. Central T1 hypointense, T2 hyperintense nonenhancing portion may represent a large cyst which may correlate with provided history of pituitary cyst. Peripheral to this area and slightly asymmetric to the left is an area of hyperintensity on both T1 and T2 which is nonenhancing on postcontrast images and may represent proteinaceous fluid or chronic blood products. The pituitary stalk is thinned and displaced posteriorly and to the right. Within the right sella is an area of hypointensity containing pre- and postcontrast nodular hyperintensities. This area could represent residual pituitary tissue with heterogeneity possibly representing postoperative alterations or conceivably intrapituitary mass. The optic chiasm is flattened, deviated to the left and pulled slightly inferiorly. Findings may correlate with provided history of pituitary cyst with additional components which may represent posttreatment effects as well as primary pathology of the pituitary. We are endeavoring to obtain images to permit direct comparison. If these become available addendum will be provided.

LESSON 2, TOPIC 54

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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