Suprasellar mass surveillance. Pituitary: There is a lobulated, enlacing pituitary tumor, eccentric to the right, with suprasellar extension, which measures up to 25 mm in axial width and 30 mm in craniocaudal height. The tumor extends into the right cavernous sinus, encasing the internal carotid artery, and exert mass effect on the adjacent optic apparatus, brain, and brainstem. There is a rounded cystic structure in the right sphenoid sinus with mild peripheral enhancement that measures up to 22 mm.Brain: There appears to be a punctate focus of enhancement in the anterior right thalamus. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse cerebral volume loss. There are scattered supratentorial and infratentorial foci of white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable.
1. A pituitary mass with supersellar extension and regional mass effect measuring up to 30 mm is compatible with a macroadenoma. The tumor appears similar in size as in April 2016, accounting for differences in technique.2. Nonspecific punctate focus of enhancement in the anterior right thalamus. 3. A cystic lesion in the right sphenoid sinus may represent a mucocele.