Headache and blurred vision. History of pituitary macroadenoma, status post resection. Head CT scan from June 5, 2016 showed evidence of enlargement. BRAIN:There is no acute infarct or intracranial hemorrhage. There is no mass-effect, midline shift or brain herniation. The ventricles and the other CSF-containing spaces are normal in size. The brain parenchyma is unremarkable. Apart from a small right frontal developmental venous anomaly, the brain shows no abnormal contrast enhancement. The major intracranial vascular flow voids are preserved.There is moderate mucosal thickening in the left maxillary, left sphenoid and posterior right ethmoid sinuses associated with frothy secretions. In the proper clinical setting, this may reflect sinusitis. Orbits are unremarkable as well. The skull and scalp soft tissues are grossly unremarkable. There is mild nonspecific thickening of the nasopharyngeal mucosa with tiny retention cysts near midline. The parotid glands remain enlarged with small intraglandular nodes.PITUITARY:Compared to the previous, postoperative examination from May 2007, there has been increase in the size of the sellar mass with regrowth of the suprasellar part of the mass. The mass measures 24 mm craniocaudally, 21 mm anteroposteriorly and 27 mm in transverse compared to 11 mm, 15 mm and 19 mm previously. The mass is multilobulated and shows heterogeneous pattern of contrast enhancement with foci of poor contrast enhancement and dark T2 signal, which may indicate small cysts with high protein content. The mass superiorly displaces and compresses the optic chiasm and hypothalamus, more on the right than on the left. Laterally, the mass extends to partially encase the horizontal cavernous segment of the left internal carotid artery, with high likelihood of left cavernous sinus invasion. The mass abuts and partially compresses the right cavernous sinus though without definite sign of invasion. Both A1 segments are abutted by the mass but remain patent. The floor of the sella has been remodeled but there is no sign of intraosseous invasion. There are also changes of previous transsphenoidal resection.
1.There has been regrowth of the pituitary macroadenoma with significant suprasellar component, and displacing and compressing the optic chiasm. There is also suggestion of involvement of the left cavernous sinus.2.The brain shows no significant abnormality otherwise.3.Mucosal thickening and frothy secretions in the paranasal sinuses may indicate sinusitis in the proper clinical setting.