Neuro_CT_Head: 33 M, left proptosis and ophthalmoplegia.

CT ORBITS WITH CONTRAST:

 

CLINICAL HISTORY: 31-year-old male, proptosis, ophthalmoplegia left eye, history of Crohn's disease.

 

FINDINGS:

 

Orbits: Mild left proptosis. Globes, extraocular muscles, and optic nerves appear intact.

 

Bones: There is a large lobulated mass with peripheral and internal coarse matrix calcifications, projecting superiorly from the central skull base. The mass measures at least 5.7 cm (AP) x 5.0 cm (transverse) x 4.4 cm (craniocaudal). There is a lobulated component that extends into the left frontal lobe. The mass occupies the sella and left cavernous sinus and fills the basal subarachnoid cisterns, displacing and compressing the brainstem posteriorly, with resultant effacement of the fourth ventricle and obstructive hydrocephalus.

 

There is displacement of the left cavernous carotid artery anteriorly and narrowing of the left supraclinoid segment, as well as 

displacement of the basilar artery posteriorly. Scattered punctate foci of enhancement are seen within the mass.

 

Soft tissues: The visualized soft tissues of the face and neck are normal.

 

Visualized paranasal sinuses: Clear.

 

Mastoid air cells: Clear.

 

Visualized brain parenchyma: Large calcified mass as described above. No evidence of acute intracranial hemorrhage or vascular territory infarct. Obstructive hydrocephalus with enlargement of the lateral and third ventricles, and effacement of the cerebral aqueduct and fourth ventricle.

 

Additional comment: None.

 

IMPRESSION:

 

1. Large lobulated, calcified mass arising superiorly from the central skull base, as described above. There is expansion and bony remodelling of the sella, left cavernous sinus, and basal subarachnoid cisterns, displacement and compression of the brainstem posteriorly, and obstructive hydrocephalus. Considerations include 

craniopharyngioma, less likely chordoma, chondrosarcoma, metastasis, giant aneurysm, meningioma, or other sellar/suprasellar calcified lesion.

(Large petroclival chondrosarcoma)