Clinical question: Rule out brain aneurysm. Signs and symptoms: Headaches CTA of intracranial circulation:Vertebrobasilar system.There is normal appearing bilateral intracranial vertebral arteries, bilateral pica branches and basilar artery. No abnormality in particular no aneurysm is detected.Carotid system there are normal bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries and their branches.There are no posterior communicating arteries identified.A very large mass within the sella with expansion of the sella and extension superiorly into the basal cistern is identified. There is no evidence of contrast within this mass. Further evaluation with dedicated MRI examination of pituitary is recommended. This mass results in significant bony remodeling/thinning and posterior displacement of dorsum sella. There is also extension of mass anteriorly and inferiorly into the sphenoid sinus and posterior right ethmoid air cells. On the right side the mass supplies mass effect and displaces the right supraclinoid internal carotid artery to the right.65 cc of Omnipaque 350 is administered for above study.
1.No evidence of vascular abnormality and in particular no aneurysm of intracranial vasculature. 2.Large expansile mass within the sella with extension into the sphenoid sinus and right posterior ethmoid air cells and with associated mass-effect and lateral displacement of supraclinoid right internal carotid artery. There is no evidence of contrast within this mass on the CTA examination.