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20b - Answer: 38-year-old male presents with pituitary macroadenoma

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

HISTORY: 

This 38-year-old male presents with pituitary macroadenoma.

(QUIZ ANSWER) MASS LOCATION: 

Suprasellar.

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

FINDINGS:

Sellar and suprasellar mass measuring 2.2cm superior inferior, 2.4cm transverse and 2.3cm anterior posterior, which markedly widens the sella extending into the sphenoid. Suprasellar portion of the lesion effaces and uplifts the optic chiasm. There is cavernous sinus extension on the left. The lesion abuts the right cavernous carotid without distinct right-sided intracavernous extension. No masses within Meckel's caves or cavernous sinuses. No retroclival extension. 

Otomastoid airspace disease. 

Cisterna magna pouch. 

No extraaxial collections or hemorrhage. 

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

No siderosis. 

Calvarium is intact. No Chiari malformation. 

No obstructive hydrocephalus. Brainstem and cerebellum are without hemorrhage, mass or edema. Midbrain and collicular plate volume are preserved. 

No internal auditory canal masses. No confluent otomastoid airspace disease. 

No enlargement of the extraocular muscles. 

CONCLUSION: 

Sellar and suprasellar mass with left-sided cavernous sinus extension consistent with provided history of pituitary macroadenoma. Lesion uplifts and effaces the optic chiasm, no retroclival extension. Sella is markedly enlarged with extension into the sphenoid. Intracarotid distance measures 2cm at the sellar level. The sphenoid is aerated.

LESSON 2, TOPIC 60

Case Challenge: Sella MRI Cases

Case Challenge

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Content reviewed: July 15, 2021

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