Presentation
Visual disturbances.
Patient Data
Large lobulated sellar mass enlarging the sellar fossa measuring 50 x 45 x 35 mm with suprasellar extension, filling the optochiasmatic cistern, compressing and displacing the optic chiasma as well as extension to the left cavernous sinus. It displays an isosignal to the cortical grey matter on both T1 and T2 with an intratumoral hemorrhagic component of high signal on T1 with fluid-fluid level well-demonstrated on sagittal T1 and FLAIR sequences. The postcontrast sequences demonstrate a moderate heterogeneous enhancement of the non-hemorrhagic component.
Case Discussion
MRI features most consistent with a hemorrhagic pituitary macroadenoma with suprasellar extension compressing and displacing the optic chiasma. No history of sudden headache, visual loss or oculomotor palsies to suggest a pituitary apoplexy.