 This exam is degraded by motion artifact, especially the postcontrast sequences..ORBITS: There is a 16 x 24 x 20 mm sellar lesion with suprasellar extension that displays intermediate to high signal peripherally and low signal centrally on both T2 and T1-weighted sequences, as well as areas of central and peripheral enhancement. There is mass effect upon the adjacent optic apparatus. There is also mild mass effect upon the bilateral cavernous sinuses. There orbits are unremarkable.BRAIN: There is no evidence of acute cerebral infarction. There are minimal nonspecific scattered punctate foci of T2 hypertensity within the supratentorial white matter that may represent chronic small vessel ischemic disease. There is a small right superior frontal gyrus developmental venous anomaly. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild paranasal sinus mucosal thickening and fluid within the bilateral mastoid air cells.
An acutely hemorrhagic sellar lesion with suprasellar extension that results in compression of the optic apparatus may represent pituitary apoplexy, possibly superimposed on an underlying mass such as a pituitary adenoma or Rathke's cleft cyst. Alternatively, this may represent an internal carotid artery aneurysm or pseudoaneurysm and this is better delineated via CTA.