Case 4

This is an MRI brain study; the salient abnormality is a large lesion in the sella turcica, causing ballooning of the bony sella and extending superiorly to compress the optic chiasm. The mass demonstrates a fluid-fluid level, caused by layering of blood products that show varying signal intensities on T1 and T2; notably, the superficial layer shows high signal intensity on both T1 and T2 weighted series. There is blooming artifact on the susceptibility weighted imaging. The lesion shows peripheral post gadolinium enhancement.

The findings represent acute haemorrhage into a pituitary mass (likely pituitary macro-adenoma), termed pituitary apoplexy.

The differential diagnosis includes Rathke cleft cyst; however, these typically show no enhancement and contain proteinaceous material rather than blood.

I would urgently contact the referring physician and recommend urgent neurosurgical consultation.