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Magnetic resonance findings in sellar and suprasellar tuberculoma with hemorrhage
Puneet Mittal1, Sarika Dua, Kavita Saggar
1Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Background:
Tuberculosis is endemic in many counteries like India. It can infect any site in the central nervous system. However, islolated involvement of the sellar and suprasellar region is rare. Sellar tuberculoma with hemorrhage is even more rare. We present magnetic resonance (MR) findings in case of sellar and suprasellar tuberculoma with hemorrhage.
Case Description:
A 40-year-old female patient presented with a 1-month history of persistent headache and blurred vision on the left side. A contrast-enhanced MR study revealed peripherally enhancing sellar and suprasellar mass with hemorrhage with compression of the left half of the optic chiasma. There was also evidence of infundibular thickening and enhancement of the adjacent dura. The mass was approached through a transphenoidal approach and was partially resected. Subsequent histopathology was suggestive of tuberculosis. The patient was put on anti-tubercular therapy. Patient reported significant improvement in symptoms. Follow-up MR done 8 months later confirmed complete regression of the mass.
Conclusion:
Because of its rarity, sellar tuberculoma is seldom considered in the differential diagnosis and is often mistaken for pituitary macroadenoma, which is the most common tumor in this region. Although rare, presence of infundibular thickening and enhancement of the adjacent dura should suggest the presence of a granulomatous lesion like tuberculoma.
Insights
Sellar tuberculoma with hemorrhage is a rare cause of sellar/suprasellar masses. Early diagnosis and anti-tubercular therapy led to complete regression of the lesion in this case.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Tuberculosis (TB) can affect the central nervous system, but isolated sellar/suprasellar involvement is uncommon.
- Sellar tuberculoma, particularly with hemorrhage, is exceptionally rare.
- This case highlights the diagnostic challenges and imaging findings of this rare condition.
Observation:
- A 40-year-old female presented with headache and blurred vision.
- Magnetic resonance (MR) imaging revealed a peripherally enhancing sellar/suprasellar mass with hemorrhage, compressing the optic chiasm.
- Infundibular thickening and adjacent dural enhancement were noted.
Findings:
- Histopathology confirmed tuberculosis after partial resection via a transsphenoidal approach.
- The patient responded well to anti-tubercular therapy.
- Follow-up MR imaging showed complete regression of the mass after 8 months.
Implications:
- Sellar tuberculoma is often misdiagnosed as pituitary macroadenoma due to its rarity.
- Infundibular thickening and dural enhancement on imaging should raise suspicion for granulomatous lesions like tuberculoma.
- Prompt diagnosis and treatment are crucial for favorable outcomes in sellar tuberculoma.
