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25b - Answer: 49-year-old male is being evaluated for abscess recurrence

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 49-year-old male is being evaluated for abscess recurrence, post brain abscess surgery.

(QUIZ ANSWER) DOES RECURRENT OR RESIDUAL ABSCESS SEEM LIKELY: 

Yes.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Normal craniocervical junction.

Normal patent basal cisterns.

Small focus of restricted diffusion at the site of the previous brain abscess is consistent with small recurrent abscess. Unfortunately, the ADC map is not provided for comparison with the diffusion-weighted image but there is clear and pronounced vasogenic edema surrounding this lesion along with distinct peripheral enhancement making this likely to represent recurrent or residual abscess.

Normal ventricular anatomy.

Scant mucosal thickening ethmoid air cells.

Patent vascular flow voids at the base of the brain and within the circle of Willis.

Normal orbits and intraorbital contents.

Normal CP angle cisterns, cochlea, vestibule, and 7th and 8th cranial nerve complexes.

CONCLUSION:

1. A 1 cm focus of restricted fluid in the left frontal lobe deep to the prior left frontal craniotomy with surrounding vasogenic edema and pronounced thick enhancement most consistent with recurrent brain abscess.

2. Patent basilar cisterns.

3. No midline shift

LESSON 3, TOPIC 45

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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