Headache. Further assessment of pituitary enlargement noted on CT scan. Pituitary: There is a heterogeneous mass within the sella turcica. The mass has a maximum height of 15 mm, compared to 11 mm in August 2011. There is no mass-effect on the optic apparatus. There is suggestion of tumor extension into the left cavernous sinus, but the cavernous internal carotid arteries are not narrowed.Brain: The study was performed without intravenous contrast given the impaired kidney function (GFR of 27 mL/m). Patchy areas of T2 hyperintensity in the parietal white-matter have very minimally increased since August 2011. Generalized mild brain volume loss results in expansion of the ventricles and sulci has not significant changed since the previous examination. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.
1.A sellar mass likely represents a pituitary macroadenoma and has increased in size since August 2011, with suggestion of left cavernous sinus invasion, but no mass-effect upon the optic apparatus.2.Mild cerebral white matter lesions likely represents chronic microvascular ischemia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.