History of CNS lymphoma and pituitary adenoma status post resection/radiation therapy presents with syncope and confusion with concern for CNS lymphoma. There are postoperative changes related to remote transphenoidal hypophysectomy. This is not a dedicated pituitary study; however, there is a grossly stable appearance of enhancing soft tissue in the right sella and right cavernous sinus. Again noted is a heterogeneous appearance with cystic appearing components within the sphenoid bone. There is again a burr hole along the right frontal bone.The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are stable scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. There is otherwise no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. A small focus of susceptibility effect is again noted in the right basal ganglia, consistent with hemosiderin deposition.Normal flow-voids are demonstrated in the major intracranial vascular structures. The remainder of the midline structures and craniocervical junction are within normal limits. There is a diminutive right maxillary sinus.There is redemonstration of a nodule in the right parotid gland.
1. No findings to suggest recurrent CNS lymphoma. No evidence of acute ischemia or intracranial mass effect.2. Heterogeneous appearance of the sphenoid bone and perisellar region status post transphenoidal hypophysectomy. Findings are compatible with post-treatment changes and residual adenoma. No interval enlargement to suggest disease progression.3. Right parotid gland nodule again noted which may represent low-grade salivary gland neoplasm or pathologic lymph node.