Female, 71 years old, history of Crohn's disease, history of breast cancer in 2005, now with recurrence in the axillary nodes, a right upper lung nodule positive on PET, and increased signal in the pituitary. Assess for pituitary adenoma versus metastasis. Along the right aspect of the sella, and involving the right cavernous sinus, there is an ill-defined region of soft tissue thickening which is asymmetric relative to the left sella and cavernous sinus (see key images). This tissue correlates with the region of hypermetabolic activity seen on prior PET scan.The visualized pituitary gland is within which can be normal for age. No additional pituitary sellar or suprasellar lesions are seen.
A region of soft tissue thickening is evident involving the right aspect of the sella and the right cavernous sinus. This does correlate with an area of hypermetabolic activity seen on prior PET scan. Without the benefit of IV contrast, no further characterization can be made. The differential diagnosis therefore remains broad and would include metastatic disease, a primary pituitary neoplasm, an incidental cavernous sinus meningioma, as well as an inflammatory/granulomatous process. 