case_images: PMC11584193_01
case_images: MRI of the suprasellar/pituitary region of the brain. T1 coronal (A) and sagittal (B) and T2 coronal images (C and D) with diffuse T1 and T2 signal loss within the pituitary gland (*). T1 signal of the normal pituitary gland should be isointense within the anterior segment and hyperintense in the posterior segment. For T2 sequences, the normal anterior and posterior pituitary should be isointense. The complete T1 and T2 signal loss in the pituitary is due to iron deposition from secondary hemochromatosis. The loss of signal intensity is lower than the adjacent bone signal. * = pituitary gland, CS = cavernous sinus, H = hypothalamus, I = infundibulum, OC = optic chiasm, C = clivus.
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case_images: T1 and T2 signal of the pituitary gland without normal enhancement (Fig. 1, Fig. 2). The remainder of the brain MRI study was unremarkable.
case_images: Noncontrast axial CT of image through the upper abdomen. Diffuse hyperattenuation of the liver (HU 88) compared to the spleen (HU 52). Additionally, there are high density upper abdominal lymph nodes (blue arrow). In secondary hemochromatosis, iron deposits in the reticuloendothelial system including the liver, spleen, bone marrow, and lymph nodes resulting in higher attenuation. Interesting in this case, the disease process spared the spleen which is on the upper limits of normal (40-60 HU).
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case_images: Review of a recent prior noncontrast CT through the abdomen demonstrated a diffusely hyperattenuating liver relative to the spleen, with Hounsfield units (HU) of 88, compared to HU of 52 respectively, as well as calcified abdominal lymph nodes (Fig. 3).
case_images: Images from a contrast-enhanced abdominal MRI from 8 years prior. T2 axial (A) and coronal (B) images show diffuse low signal throughout the liver (lower than muscle) consistent with hemochromatosis. T1 opposed-phase (C) and T1 in-phase (D) shows significant loss of signal throughout the liver with the longer echo time (in-phase images). Contrast-enhanced axial T1 image (E) again shows abnormal signal loss throughout the hepatic parenchyma relative to other abdominal organs. Axial R2* map from an iron quantification sequence (F) confirmed severe iron overload.
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case_images: Additionally, an abdominal MRI performed 8 years prior demonstrated a similar abdominal pattern of hemochromatosis with marked diffuse signal loss throughout the liver, most evident on sequences with longer echo times (T2-weighted images, and T1 in-phase with echo time of 4.4 msec relative to T1 opposed-phase with echo time of 2.1 msec) (Fig. 4).