Signs of optic nerve compromise: decreased vision OD. Brain: There is a low T1 and high T2 signal right sellar tumor with suprasellar extension and susceptibility effect as well as possible peritumor cyst formation that measures up to 23 mm and exerts marked mass effect upon the optic apparatus and inferior right frontal lobe. There is also mass effect upon the right cavernous sinus. The tumor also abuts and perhaps encases a portions of the adjacent right internal carotid artery. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. 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.Orbits: There is engorgement of the right superior ophthalmic vein due to mass effect upon the right cavernous sinus. The right intraorbital optic nerve appears to be mildly atrophic. The left intraorbital optic nerve appears to be grossly intact. The globes, extraocular muscles, lacrimal glands, and orbital fat are intact bilaterally.
A right sellar tumor with suprasellar extension measuring up to 23 mm exerts mass effect upon the optic apparatus and likely represents a pituitary macroadenoma with prior intratumoral hemorrhage. The right intraorbital optic nerve appears to be mildly atrophic perhaps due to chronic pressure-induced effects by the tumor. Assessment is otherwise limited due to the lack of intravenous contrast, acknowledging pregnancy status.Discussed with Dr. Zeyer at 2 PM on 7/1/16.