File:Angioinvasive aspergillosis in the pituitary fossa (Radiopaedia 39676-42010 Axial ADC 37).png

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Angioinvasive_aspergillosis_in_the_pituitary_fossa_(Radiopaedia_39676-42010_Axial_ADC_37).png ‎(512 × 512 pixels, file size: 6 KB, MIME type: image/png)

Summary:

Description
  • Radiopaedia case ID: 39676
  • Image ID: 15879753
  • Image stack position: 37/37
  • Plane projection: Axial
  • Aux modality: ADC
  • Study description: MRI Brain (ischemia protocol - related with the current presentation)
  • Study findings: No evidence of midbrain infarction or mass in the interpeduncular cistern. Only non contrast T1 sequences targeted to the pituitary have been performed, but on these images, it appears that the suprasellar component of the tumor is now contacting the inferior surface of the chiasm, not present on the corresponding location on MRI. In addition, there appears to be a focus of diffusion restriction (note this is close to bone) at the site of this solid component of the pituitary tumor on the left of the sella that is protruding superiorly into the suprasellar cistern. No T1 hyperintensity or increased right sided stalk deviation. The left cavernous sinus appears invaded, but not significantly changed. Definite diffusion restriction in the left caudate head, in keeping with acute infarction. There are also patchy diffusion restriction in the left occipital lobe. Equivocal diffusion restriction along the left hippocampus. Bilateral deep white matter FLAIR hyper intensities are slightly more prominent. Bilateral FLAIR hyper intensities in the pons are again noted. Conclusion: On limited T1 non contrast sequences, there appears to be increased left suprasellar tumor mass effect on the chiasm since the previous MRI. No definite evidence of hemorrhage, but hyperacute hemorrhage may be T1 isointense. After hours radiology reg will contact the stroke team to determine best timing of recalling the patient for further detailed evaluation of this region with FIESTA, thin slice T2 coronals, and contrast. Left caudate head infarct. MRI Brain Comparison made with the imaging from earlier today. A T2 weighted coronal sequence through the pituitary fossa was obtained. Despite the appearance on the T1 pre contrast scan earlier today, the optic chiasm on this T2 sequence is not contacted by the sellar/suprasellar mass, and appears unchanged from the T2 sequence performed previously. FIESTA sequence demonstrates a large volume of movement artifact and is non-diagnostic. The patient could not be sedated after-hours when this study was performed. Post-contrast study also not performed. This was discussed with the neurosurgical unit who will organize appropriate in-hours sedation.
  • Modality: MRI
  • System: Central Nervous System
  • Findings: Enlarged pituitary fossa, remainder of the exame is unremarkable (CT brain scan performed two years previously to the presentation).
Date Published: 17th Sep 2015
Source https://radiopaedia.org/cases/angioinvasive-aspergillosis-in-the-pituitary-fossa
Author RMH Neuropathology
Permission
(Permission-reusing-text)		 http://creativecommons.org/licenses/by-nc-sa/3.0/

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