File:Angioinvasive aspergillosis in the pituitary fossa (Radiopaedia 39676-42015 Axial T2 27).png

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Angioinvasive_aspergillosis_in_the_pituitary_fossa_(Radiopaedia_39676-42015_Axial_T2_27).png ‎(512 × 512 pixels, file size: 251 KB, MIME type: image/png)

Summary:

Description
  • Radiopaedia case ID: 39676
  • Image ID: 15885899
  • Image stack position: 27/28
  • Plane projection: Axial
  • Aux modality: T2
  • Study findings: Thin axial T2 images through the brainstem demonstrate no focal abnormality, other than minor chronic small vessel ischemic change throughout the cord is mild tracts and pons. No dorsal midbrain/tectal lesion, no compression of the superior colliculi. Heterogeneous enhancement of the pituitary region with enlargement of the pituitary fossa and displacement of the infundibulum towards the right is again noted. There appears to be invasion of both cavernous sinuses, particularly on the left with enhancing tissue encircling the internal carotid artery. Additionally, on the postcontrast T1 coronal sequence from today, thin enhancement is seen coating the optic chiasm and left optic nerve. Significance of this is uncertain, however it was not present previously. No convincing leptomeningeal enhancement can be detected elsewhere. Within the very posterior aspect of gyrus rectus on the left, extending superiorly to the floor of the frontal horn of the left lateral ventricle (at most involving the most inferior part of the head of caudate) is a subcortical region of high T2 signal which does not suppress on flair and does not demonstrate contrast enhancement. This region is shown to abnormally restrict on the earlier study consistent with infarction. Left occipital cortical and left hippocampal increased T2 signal is demonstrated, (series 3 image 19) which correlates with restricted diffusion in the earlier study from June 18, and represents further acute ischemic change. Conclusion: Multiple areas of increased T2 signal are again noted in the territories of previously demonstrated restricted diffusion. Leptomeningeal enhancement surrounding the left side of the optic chiasm is a new finding when compared to previous studies, although the significance is uncertain. A leptomeningeal process (infection/malignancy) is suspected and further assessment with lumbar puncture is recommended. Cranial nerve palsies on the left yearly relate to cavernous sinus invasion by pituitary tumor.
  • 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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