Case 35 - Abscess: MRI

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

MRI BRAIN W/WO CONTRAST

INDICATION: Follow up cranial abscess

TECHNIQUE: Multiplanar multisequence magnetic resonance images of the brain with and without intravenous contrast.

COMPARISON: MRI brain dated 2/2/2020, MRI brain dated 2/03/2020.

FINDINGS:

Although there has been prior bicoronal craniotomy for evacuation of left frontal abscess and obscuration of the frontal sinuses. A 3.0 x 2.8 x 2.6 cm rim enhancing T2 centrally hyperintense fluid collection centered in the left frontal lobe with intrinsic restricted diffusion, T2-hypointense rim and significant surrounding vasogenic edema. Findings are concerning for residual abscess.

The abscess cavity is decreased in size when compared to MRI brain dated 2/2/2020. There are blood products around the resection cavity. Similar degree of left frontal lobe vasogenic edema is noted with significant mass effect and rightward midline shift measuring up to 1.2 cm along the anterior falx, unchanged. Small amount of postoperative blood products are noted subjacent to the bicoronal craniotomy site. Dural thickening and enhancement along the left greater than right frontal convexities are suggestive of postsurgical changes, although meningitis may also result in a similar appearance. The previously noted left subdural empyema has significantly decreased in size.

Unchanged size and morphology of the ventricles. The larger intracranial vascular flow voids are maintained. Intraorbital contents are within normal limits. No significant mucosal thickening is noted in the paranasal sinuses. Obscuration of the frontal sinuses are noted. Trace right and small left mastoid effusion.

IMPRESSION:

1. Postsurgical changes of bifrontal craniotomy, bifrontal sinus obliteration, and left frontal lobe abscess drainage. When compared to MRI brain dated 2/2/2020, there is interval decrease in size of the rim-enhancing fluid collection associated with vasogenic edema and intrinsic restricted diffusion now measuring 3.0 x 2.8 x 2.6 cm, compatible with residual brain abscess.

2. Stable vasogenic edema within the left frontal lobe with unchanged left to right midline shift.

3. When compared to MRI brain dated 2/2/2020, there is marked decrease in size of the previously seen subdural empyema/epidural abscess.