Hyperdense MCA sign - importance of fine slice interrogation

Case contributed by Chris O'Donnell
Diagnosis certain


Acute onset right hemiparesis with altered conscious state. No significant medical history.

Patient Data

Age: 65 years
Gender: Male

On the repositioned orthogonal thick slices there is a macroadenoma of the pituitary and subtle hyperdensity of the right MCA.  No hemorrhage or hypodensity in the supplied brain parenchyma.  The hyperdense right MCA is obvious on the fine slices (original data set).

Filling defect within the right M1 in keeping with occlusive thrombus as shown on the non-contrast CT.

Case Discussion

This case exemplifies three important rules for interpretation of CT:

  1. Do not stop looking at the remainder of the study when you see obvious pathology ie a macroadenoma of the pituitary.
  2. Always interrogate the original fine slice data set (not just the pretty thick MPRs).
  3. Always read the clinical notes and correlate the CT findings with the clinical concern (in this case the macroadenoma is completely incidental).

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