Per EPIC, Cushing's disease secondary to ACTH-secreting microadenoma status post transsphenoidal hypophysectomy on 6/1. Fever and elevated white count. Evaluate for abscess in the sella. There are postoperative findings related to transsphenoidal hypophysectomy. There is a small rim-enhancing fluid collection at the left aspect of the sella measuring approximately 4 x 7 x 5 mm (AP x TR x CC) with prominent surrounding enhancement in the sella. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There is no evidence of parenchymal abscess or empyema. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There are acute on chronic changes with diffuse mucosal thickening of the paranasal sinuses.
1.Please note examination was performed as a brain MRI and suboptimal for evaluation of the sella. There is however a discrete 4 x 7 x 5 mm fluid collection in the left aspect of the sella with prominent surrounding enhancement. Although some of these changes can be seen postoperatively, the possibility of abscess can not be excluded. 2.No evidence of parenchymal edema, parenchymal abscess, or extra-axial collection to suggest empyema.