51-year-old male with acute psychosis, history of pituitary adenoma There is redemonstration of a large sellar lesion measuring 4.1 x 3.3 x 2.2 cm in sagittal and coronal planes (sagittal image 28, coronal image 32). While the size of the sellar lesion is similar to 2004, the mass appears heterogeneously hypodense on CT which is surprising based on prior MRI appearance which was more solid appearing. This may suggest interval treatment. As before, there is remodeling of the sella by the mass, with distortion of the posterior walls of the sphenoid sinus. Relationship to the chiasm is poorly defined based on this CT.There is no acute intracranial hemorrhage with special attention to the abnormal sella turcica. There is also no focal fluid collection. Ventricles and sulci retain normal size/configuration.Gray-white matter differentiation is preserved. There is no focal parenchymal lesion or mass. There is no midline shift or basal cistern effacement.Unremarkable visualized portions of the orbits. Paranasal sinuses are clear to the extent visualized. Mastoid air cells are also clear. Probable small quantities of cerumen in the external auditory canals.
1.No acute intracranial abnormality. Specifically no acute intracranial hemorrhage or generalized mass effect.2.Redemonstration of remodeled sella consistent with previously seen pituitary adenoma. The contents of the sella are now predominately hypodense which raises possibility of interval treatment. MRI would be required to evaluate extent of remaining tumor and to define relationship to surrounding structures.