PMC6803741_01
(a) The patient was asked to open both eyes. (b) Both upper eyelids were passively opened. There is a clear anisocoria with down and outward left gaze palsy.
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After around 12 hours of cardiac catheterization, the patient developed acute left-sided ptosis, deviated gaze (down and outward palsy), and anisocoria with left pupillary dilation (mydriasis) consistent with acute left 3rd nerve palsy (Figure 1).
MRI head with contrast T1. (a) Sagittal view showing an enlarged pituitary gland. It measures 1.9 x 2.0 cm in the greatest dimension. The mass is slightly heterogeneous in signal and is slightly impressing on the optic chiasm. (b) and (c) Coronal view with different cuts showing extension on the left cavernous sinus.
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The MRI report, as read in our hospital, indicated a nonenhancing heterogeneous pituitary mass measuring 1.9 x 2.0 cm in the greatest dimension and slightly compressing on the optic chiasm suggestive of pituitary macroadenoma (Figure 2(a)). The lesion appeared to extend laterally into the left cavernous sinus with mild mass effect on the cavernous internal carotid artery. The overall hypoenhancing portion measured 2.1 x 1.9 x 1.3 cm (Figures 2(b) and 2(c)).
CT head without contrast (sagittal view) showing enlarged sella turcica with increased attenuation suggesting a possible hemorrhage within the tumor.
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The new CT scan report indicated increased attenuation of the sella turcica and in the suprasellar cistern at the site of the patient's pituitary mass, suggestive of possible hemorrhage within the tumor (Figure 3).