Pituitary mass. Ptosis and ophthalmoplegia. The sella turcica is expanded by a heterogeneous lesion with thin peripheral enhancement. Overall, the lesion measures 3.2 cm x 2.1 cm in the coronal plane and 1.7 cm in the anteroposterior dimension and there is associated suprasellar extension with mild mass effect upon the optic apparatus, particularly on the left side. In addition, the lesion also extends laterally into the bilateral cavernous sinuses and the left cavernous sinus appears to be mildly prominent and heterogeneous. The pituitary infundibulum is slightly thickened and displaced to the right. There is mucosal thickening in the sphenoid and posterior ethmoid sinuses which is associated with T1-hyperintense fluid on the left side. There appears to be mild enhancement of the sphenoid body. There is diffuse dural thickening and enhancement.
1.The sellar lesion that measures up to 3.2 cm produces mass effect upon the optic apparatus may represent a pituitary adenoma with apoplexy versus an abscess that could be associated with adjacent sinusitis and possible early central skull base osteomyelitis. 2.The slightly heterogeneous appearance and thickening of the cavernous sinuses, particularly on the left may represent cavernous sinus thrombosis versus compressive effects by the adjacent lesion. Follow up via dedicated CT venography may be useful.3.Diffuse pachymeningeal thickening may be related to a recent lumbar puncture.