Presentation
Patient with a progressive worsening vision on left eye.
Patient Data
Comparison made with the previous CT studies from today and yesterday.
A well-circumscribed mass is present within the expanded sella tursica. This mass has suprasellar extension and demonstrates iso-intense signal on T1 weighted imaging, heterogeneous but predominantly low signal on T2 weighted imaging, and has predominantly peripheral enhancement. Gradient echo images demonstrate blooming artefact consistent with hemorrhage in the mass.
The lesion mildly bulges into the right cavernous sinus with no definite invasion. The optic chiasm is superiorly displaced by the mass and drapes over it. The lesion elevates anterior aspect of floor of the third ventricle without causing hydrocephalus. The remainder of the imaged brain (please note this study has been targeted to the pituitary, and as such the whole brain has not been imaged) appears unremarkable.
Conclusion:
Findings are consistent with pituitary macro adenoma with hemorrhagic infarction (apoplexy).
Findings have been discussed with the treating team.
Case Discussion
Pituitary apoplexy is an acute clinical syndrome caused by either hemorrhagic or non hemorrhagic necrosis of the pituitary gland. As in this case, an existing pituitary macroadenoma is usually present in 60-90%.
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