case_images: PMC4887828_01
case_images: CT head scan images. An enhancing mass is seen in the pituitary fossa (Arrow, A). There is also overlying optic tract oedema (Arrow, B), not typically seen with pituitary adenomas.
case_images: omw04401.jpg
case_images: PMC4887828_01_omw04401.jpg
case_images: OMW044F1
case_images: An urgent computed tomography (CT) brain scan was performed, revealing an enhancing (1.5 x 1.7 cm) suprasellar mass (Fig. 1A). There was also oedema of the overlying optic tract (Fig. 1B), a finding most unusual for primary pituitary adenoma.
case_images: MRI brain scan, coronal (A) and sagittal (B) views are shown. The known pituitary mass is seen (red arrow), but now with marked hypothalamic extension (yellow arrow). The pituitary and hypothalamic masses were deemed to be continuous after detailed review by a specialist neuroradiologist, although this is not easily apparent on any one image.
case_images: omw04402.jpg
case_images: PMC4887828_01_omw04402.jpg
case_images: OMW044F2
case_images: This showed the known pituitary mass, but now larger with marked hypothalamic extension (Fig. 2).
case_images: Patient's chest radiograph. There is a pseudo-nodular shadow visible at the left lung hilum (arrow).
case_images: omw04403.jpg
case_images: PMC4887828_01_omw04403.jpg
case_images: OMW044F3
case_images: A chest X-ray also uncovered a suspicious left pseudo-nodular shadow at the level of the aortic arch (Fig. 3) and a subsequent CT thorax confirmed a left lung mass lesion with impingement into the left main pulmonary artery (Fig. 4).    