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Chiropractic Research Review

Imaging Concerns of an "Empty Sella"

The sella turcica, the saddle-like prominence on the upper surface of the sphenoid bone, can be divided into two halves. An empty sella, defined as a sella that is at least partially filled with cerebrospinal fluid, can be enlarged or normal in size.

While normal-sized empty sellas can be regarded as a normal variant, an enlarged empty sella is often associated with symptoms such as headache, obesity and visual disturbances that may be a sign of underlying pituitary disease.

This paper discusses the empty sella by detailing the characteristics of the normal sella vs. the empty sella, then evaluating the diagnostic imaging findings in a chiropractic patient presenting with headache, dizziness, vomiting and diarrhea. Emphasis is placed on magnetic resonance imaging (MRI) of normal and abnormal pituitary appearances. The authors discuss the case in detail and draw conclusions from the evidence:

* An enlarged empty sella can be present without symptoms and can represent an incidental finding on radiography and MRI.

* An enlarged empty sella seen on lateral cervical spine radiographs should prompt further evaluation to rule out pituitary disease.

The authors also note that "the cause of an enlarged empty sella receiving the most support in the recent literature is that of a pituitary adenoma that has undergone necrosis and/or hemorrhage." The authors suggest that MRI, because of its noninvasive capacity to provide definition of soft tissues, is the ideal diagnostic modality for evaluating the pituitary.

Atherton WW, Kettner NW. The empty sella. Journal of Manipulative and Physiological Therapeutics, Sept. 1999:22(7), pp478-82.
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Chiropractic Research Review

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