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Diffusion-weighted MRI findings in a patient with pituitary abscess.

A 74-year-old man, who had undergone transsphenoidal surgery for pituitary adenoma 1 year previously, was admitted to our hospital because of headache and fever. Since his physical examination revealed neck stiffness, a spinal tap was performed. Protein concentration in the cerebrospinal fluid was 297 mg/dL; glucose concentration, 22 mg/dL; and white blood cell count, 955/mm (polymorphonuclear cells, 80%). Gadolinium enhanced T1-weighted images showed a ring-enhanced cystic mass in the pituitary fossa with suprasellar extension (Picture 1). Moreover, diffusion-weighted imaging (DWI) showed the lesion as a high intensity area (Picture 2). The laboratory findings strongly suggested a pituitary abscess. Subsequently, transsphenoidal surgery was again performed. The pituitary gland was filled with yellowish pus, and Streptococcus intermedius was detected. Pituitary abscess is a rare condition, which mimics many other intrasellar mass lesions. It has been reported that high intensity signal is observed in pyogenic abscesses on DWI (1). This case suggests that DWI can be used to distinguish pituitary abscesses from cystic or necrotic tumors (2).