Acromegaly, failed previous surgery, transsphenoidal surgery in 2013. There is evidence of prior transsphenoidal surgery. There is soft tissue with low T1 and low T2 signal and minimal enhancement along the inferior aspect of the sella where it measures approximately 6 mm in the craniocaudal dimension, 15 mm in the AP dimension, and 18 mm in the transverse dimension. Soft tissue extends laterally on the right and partially fills the right cavernous sinus with the right cavernous sinus portion measuring 11 x 10 mm in the craniocaudal and transverse dimensions. No narrowing of the cavernous internal carotid arteries. Homogeneously enhancing tissue within the upper aspect of the sella is consistent with residual normal pituitary tissue. Infundibulum remains in the midline. No suprasellar extension or evidence of mass effect on the optic chiasm is appreciated.Evaluation of the remainder of the brain demonstrates no intracranial mass or mass effect. No evidence of acute ischemia or hemorrhage. No abnormal parenchymal or meningeal enhancement. No hydrocephalus. No extra-axial collections. Brain parenchyma appears within normal limits. Major flow-voids are preserved. Mild diffuse calvarial thickening is noted and compatible with known acromegaly.
Extensive lobulated soft tissue involving the inferior aspect of the sella and extending into the right cavernous sinus is highly suspicious for residual tumor. The tumor is very mildly enhancing which is somewhat unusual but of uncertain significance. Preoperative MRI would be helpful for comparison.