 There is smooth osseous expansion involving the right aspect of the sella as seen on recent CT study. There is a peripherally enhancing lesion measuring up to 26 x 26 x 28 mm in the AP, transverse, and craniocaudal dimensions which involves the sella, suprasellar cistern, and right cavernous sinus. Superiorly mass abuts the optic chiasm although not well seen due to the motion degradation. There is questionable abnormal signal involving the optic chiasm which can be better assessed with a dedicated orbit study. Normal enhancing pituitary tissue is not definitively identified.There is a punctate focus of restricted diffusion in the right frontal lobe associated with T2/FLAIR hyperintensity consistent with acute infarct. No other foci of infarct are evident. There is also a punctate focus of diffusion hyperintensity involving the left occipital horn which was present on outside MRI which may represent pus or blood products. There is normal ventricular size. No brain parenchymal mass or abnormal meningeal enhancement. No findings to suggest parenchymal edema. There is no midline shift or herniation. There are nonspecific scattered foci of hyperintensities in the subcortical and the periventricular white matter, most consistent with chronic small vessel ischemic disease. There are scattered foci of susceptibility compatible with chronic hemorrhage including the right caudate head, right cerebellar hemisphere, as well as a slightly larger area in the right temporal lobe. Mucous retention cysts are seen in both maxillary sinuses.
1. Peripherally enhancing mass involving the sella, right cavernous sinus, and suprasellar cistern as described above. There is smooth osseous remodeling of the sella and clivus suggesting a chronic underlying lesion (such as macroadenoma for example). The peripheral enhancement pattern however is most worrisome for infection/abscess, possibly superimposed on a chronic underlying lesion. Necrotic macroadenoma or other necrotic tumor may also have this appearance. 2. There is a punctate focus of restricted diffusion consistent with acute infarct in the right frontal lobe. No obvious narrowing of the right internal carotid artery is demonstrated. However as mentioned above, the enhancing lesion encases the right cavernous internal carotid artery. 3. Punctate focus of diffusion hyperintensity layering within the left occipital horn which may represent pus or other debris. This finding was present on prior prior from 12/16/2015. If there is possibility of intracranial infection, consider CSF sampling. There is however no abnormal parenchymal or meningeal enhancement in the brain parenchyma or findings to suggest cerebritis.4. Chronic small vessel ischemic disease and evidence of chronic microhemorrhages. Slightly larger focus of chronic hemorrhage is seen with the right temporal lobe.5. Mass extends to the level of the optic chiasm. There is also questionable signal abnormality involving the optic chiasm. Given motion degradation on the current study and brain MRI technique, MRI orbit/sella may be helpful for more detailed visualization.Dr. Ali discussed findings with Dr. Platt at 1610 hours on 12/20/2015.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.