PMC8604177_01
Pre- and post-operative neuroradiological studies identifying the brain abscess. (a) Axial (left) and coronal (right) non-contrast CT head demonstrate a hypodense 2.5 cm right anterior temporal lobe lesion. (b) Axial T2-FLAIR, DWI, and post-contrast T1 weighted images demonstrate a right anterior temporal cystic lesion with surrounding vasogenic oedema (left). There is central restricted diffusion (middle) and subtly peripheral enhancement (right, arrow) consistent with abscess. (c) Post-operative coronal and axial post-contrast T1 weighted images (left and middle) and axial T2-FLAIR images (right) demonstrate a post-operative hematoma in the right temporal lobe with persistent peripheral enhancement due to possible residual abscess.
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F1
The cystic lesion demonstrated peripheral enhancement along with restricted diffusion on diffusion weighted imaging (DWI) suggesting a diagnosis of an abscess (Fig. 1a, b). However, the vasogenic perilesional oedema was persistent. (Fig. 1c).
Pituitary expansion and erosion of the sella turcica. (a) Pre-operative CT in bone window demonstrates an intact anterior sella wall without evidence of dehiscence and pituitary herniation. (b) Post-operative day 6 CT sinus in bone window demonstrates a defect in the anterior wall of the sella with herniation of sellar contents into the bilateral sphenoid sinus. (c) Post-operative day 7 T1-weighted MRI images demonstrates a heterogeneously enhancing pituitary tissue herniating through anterior sellar defect into bilateral sphenoid sinuses.
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F2
The CT of the head obtained at this time (post-operative day 6) demonstrated a new bony defect at the central skull base involving the anterior wall of the sella with herniation of its contents into the sphenoid sinus (Fig. 2). T1 and T2 weighted images and contrast enhancement in the gland suggesting infection with no identification of a drainable abscess (Fig. 2). The patient was fluid restricted with gradual improvement in his sodium levels to normonatremia.
Resolution of the pituitary expansion and erosion of the sella turcica. (a) CT sinus bone windows demonstrates resolution of herniation of pituitary tissue and repair of sellar defect. (b) Post-contrast T1-weighted MRI demonstrates resolution of pituitary tissue herniation with normal enhancement pattern.
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F3
Interestingly, pituitary enlargement seen previously was no longer visualized and the sella appeared grossly unremarkable (Fig. 3).