PMC5894024_01
CT of the nasal cavity and paranasal sinuses performed without contrast. There is a large isodense mass centered in the sphenoid sinus and sella (encircled in A) with scattered calcifications (arrows in B). The mass fills the sphenoid sinus eroding it inferiorly. It extends into the right pneumatized pterygoid (arrowheads in C). There is also extension into the posterior fossa with effacement of the prepontine cistern and involvement of both cavernous sinuses.
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A CT scan of the sinuses was obtained (Figure 1) which revealed a large, expansile, erosive mass within the midline sphenoid sinus.
MRI examination of the brain and pituitary gland performed before (A) and after (B) administration of 14 ml of Magnevist intravenous contrast. A large mass involves the upper portion of clivus and the sphenoid sinuses can be observed. The mass extends to involve the pneumatized portion of the right sphenoid sinus. The internal septations correspond to the calcifications observed on the CT scan (Figure 1), suggesting an internal calcified matrix. The mass abuts both cavernous carotid arteries (arrowheads, C). Scattered foci of hyperintense T2 and FLAIR signals are also observed in the white matter, suggestive of mild microangiopathy (arrow in C).
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Brain MRI performed before and after administration of 14 ml of contrast (Magnevist) revealed a large mass involving the clivus and the sphenoid sinus, predominantly on the right and with the same characteristic findings as on CT (Figure 2).
(A, B) CT scan of the brain performed with Stryker protocol without administration of intravenous contrast; status post trans-sphenoidal approach for resection of a large skull base mass. The mass is resected with residual air and packing material observed.
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The postoperative non-contrast CT (Figure 3) of the nasal cavity and paranasal sinuses showed residual air and packing material, but no hemorrhage or abnormal fluid collections.
MRI of the brain obtained using a pituitary protocol, 14 ml of Magnevist was administered; status post trans-sphenoidal resection of a large mass at the skull base. A thin rim of irregularly enhancing soft tissue is observed at the resection site, most pronounced superiorly. A T2 hyperintense signal is observed (arrow) without enhancement and likely represents cystic changes.
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MRI performed 2 days after resection, with and without contrast (14 ml of Magnevist), revealed a thin rim of irregularly enhancing soft tissue superiorly, most likely representing postoperative soft tissue changes or minimal residual tumor, and a hyperintense cystic mass located superiorly (Figure 4).