Diagnosis = Aneurysm

Diagnosis: Cerebral aneurysm with calcifications

Findings on Imaging:

  • CT scan of the brain shows a hyperdense mass within the sella turcica that appears to be calcified.
  • MRI of the brain shows a lobulated mass with peripheral enhancement and low T2 signal intensity within the sella turcica, suspicious for a pituitary adenoma or other sellar mass.
  • Digital subtraction angiography (DSA) confirms the presence of an aneurysm arising from the internal carotid artery with calcifications along its wall, consistent with a calcified cerebral aneurysm.

Next Steps in Management:

  • Management of a cerebral aneurysm with calcifications depends on the size and location of the aneurysm, as well as the patient’s overall health and risk factors for rupture.
  • Treatment options include observation, endovascular coiling, and surgical clipping.
  • In this case, the aneurysm is located in the sella turcica and may require a transsphenoidal approach for surgical intervention.

Key Take Away Points:

  • Cerebral aneurysms can present with calcifications on imaging, which may mimic other types of intracranial masses, such as pituitary adenomas.
  • DSA is a useful tool for confirming the diagnosis of a cerebral aneurysm and determining the appropriate management.
  • Treatment options for cerebral aneurysms with calcifications depend on the size and location of the aneurysm and may include observation, endovascular coiling, or surgical clipping.
  • A transsphenoidal approach may be necessary for surgical intervention in aneurysms located in the sella turcica.

Case credit: Image submitted by Dr. Richard Segev MD